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V 



MORTALITY STATISTICS 
OF INSLRED WAGE-EARNERS AND 
-THEIR FAMILIES 



EXPERIENCE OF THE METROPOLITAN LIFE INSURANCE COMPANY 

INDUSTRIAL DEPARTMENT, 1911 TO 1916, IN THE 

rNITED STATES AND CANADA 



LOUIS I. DUBLIN, Ph.D. 

STATISTICIAN 
"WITH THE COLLABORATIOX OP 

EDWIX W. KOPF 

AflSISTA2tT STATISnCAK 
AND 

GEORGE H. VAX BUREX 

erPEETISOB, STATISTICAl. BUBEAC 



NEW YORK 

Metropolitan Life Insurance Company 

1919 



Gift; 




<^5 



To 

HALEY FISKE, Esq. 

President 
Metropolitan Life Insurance Company 

whose broad vision of the aims and 
purposes of Industrial Insurance 
inspired the produc- 
tion of this 
work. 



PEEFACE. 

It has been one of the major activities of the Statistical Bureau 
of the Metropolitan Life Insurance Company to compile the medical 
statistics of mortality among policyholders of the Industrial De- 
partment. After seven years' work, data are available in consider- 
able detail for the many millions of policyholders who constitute 
its membership. In fact, nearly fifty million years of life and 
more than 635,000 deaths are represented in the period 1911 to 
1916 covered in this report. The volume is an analysis of this 
material and is submitted as a contribution by the Company to the 
public health movement in the United States and Canada. 

Facts herein compiled have already had wide public uses. From 
time to time, reports have been issued in scientific and medical 
journals on various diseases and conditions. A large part of the 
whole field of mortality statistics has been considered and a mass of 
important scientific information has been put into circulation. 
The completeness and accuracy of the data have commended the 
studies to physicians and others who are guided in their work by 
medical statistics. 

The present volume is, however, more than a compilation of the 
papers and reports which have appeared in recent years. The 
previous discussions have been much amplified and much new in- 
formation has been added. The report is, in fact, a comprehensive 
treatment of the entire field of mortality as related to wage earners 
and their families. 

This work should serve as a supplement to general population 
mortality statistics as published by the Bureau of the Census and 
by the several State and municipal registration offices. Large areas 
of the country still outside the Eegistration Area of the United 
States are included in the insurance field and for these sections 
there are as yet no authentic compilations of mortality statistics. 
This report also contrasts the mortality experience of wage earners 
and of the general population. The medical profession especially 
will profit from the study of the individual diseases with their de- 
tail of death rates by color, sex and age period. In some cases, the 
figures will suggest new lines of medical research. 



IV PEEFACE. 

It is appropriate that the insurance companies should contribute 
to the advance of medical science and to the public health move- 
ment. The extensive health work carried on by the Metropolitan 
demands that a specific answer be given to the many persons who 
are interested to know what the effect of the life conservation pro- 
gramme has been on the mortality experience of policyholders. 
Health and social workers all over the country are awaiting a 
report, showing the extent of the mortality saving among insured 
lives and the diseases and conditions which have been most affected. 

In presenting this volume to the public, the author desires to 
acknowledge how completely this and other scientific contributions 
from the Statistical Bureau are the result of the continued co- 
operation and encouragement of the executives of the Company. 
To Dr. Lee K. Frankel, Third Vice President, his obligation is 
especially great for the many suggestions concerning the develop- 
ment of the Bureau's work. It is appropriate also that proper 
acknowledgment be made to the medical profession of the United 
States and Canada. About thirty-five thousand letters from 
thousands of physicians have materially helped to complete and 
clarify the medical data in obscure cases. Finally, it is a pleasure 
to acknowledge the loyal and effective assistance received through- 
out the progress of this work from Mr. Edwin W. Kopf, Assistant 
Statistician, and from Mr. George H. Van Buren, Supervisor, both 
of whom I am honored to have associated with me in this publi- 
cation. 

Louis I. Dublin. 

Sept. 12, 1918. 



CONTENTS 

PAGB 

Preface iii-iv 

Chapter I — Introductory 1-10 

Uses of Industrial Insurance Medical Statistics^ — Scope of 
the Present Statistics with respect to Area, Occupation, and 
Color, Sex and Age — Technical Processes of Compiling the 
Statistics. 

Chapter II — Mortality from All Causes of Death Com- 
bined 11-29 

Deaths and Death Bates according to Color, Sex and Age — 
Death Rates of White Persons in Insurance Experience Com- 
pared with Death Eates in Expanding Eegistration Area of 
the United States, by Sex and by Age Period — Factors Influ- 
encing Industrial Insurance Mortality — Downward Trend of 
Mortality among Insured Wage Earners. 

Chapter III — Mortality from Principal Causes of Death 30-42 
'Sources of Data — Improving Accuracy of Certified Causes of 
Death of Wage Earners — Nomenclature and Classification of 
Diseases. 

Chapter IV — Tuberculosis 43-64 

Mortality according to Organs or Parts Affected — Mortality 
from Tuberculosis of the Lungs according to Color, Sex and 
Age Period — Types of Pulmonary Tuberculosis Mortality 
among Wage Earners — Mortality among Insured Wage 
Earners and Population of Expanding Registration Area 
Compared — Trend of Tuberculosis Mortality — Tuberculous 
Meningitis — Abdominal Tuberculosis — Tuberculosis of Other 
Organs. 

Chapter Y — Organic Diseases of the Heart 65-71 

Heart Disease Mortality according to Color, Sex and Age 
Period — ^Mortality among Insured Wage Earners and among 
Population of Expanding Registration Area — Trend of the 
Death Rate — iCertification of Diseases of the Heart. 

Chapter VI — Pneumonia 72-86 

a. Pneumonia (Lobar and Undefined) : 

Mortality from' Pneumonia according to Color, Sex and 
Age — Pneumonia as a Cause of Death among Wage 
Earners and among General Population of Expanding 



VI CONTENTS. 



Registration Area Compared — Effect upon Pneumonia 
Mortality Statistics of Improvement in Certification 
of Causes of Death. 
h. Bronchopneumonia: 

Mortality from Bronchopneumonia according to Color, 
Sex and Age — Trend of Bronchopneumonia Mortality — 
Bronchopneumonia among Insured Wage Earners and 
among Population of Expanding Eegistration Area Com- 
pared' — Reliability of Mortality Statistics of Broncho- 
pneumonia. > 

Chaptee YII— Blight's Disease 87-92 

Complications of Bright 's Disease with Cardiovascular Dis- 
eases — ^Bright's Disease Mortality according to Color, Sex 
and Age Period — Bright 's Disease among Insured Wage 
Earners and among General Population of Expanding Regis- 
tration Area Compared — Trend of the Death Rate. 

Chapter VIII — External Causes of Death (Accident, 

Suicide and Homicide) 95-146 

a. Accidents, including Unspecified Violence: 

Accident Death Rate according to Color, Sex and Age 
Period — ^Fatal Accidents among Insured Wage Earners 
and among Population of Expanding Registration Area 
Compared — Fatal Accidents according to Specific Means 
or Nature of Injury: Traumatism by Pall — Accidental 
Drowning — ^Burns (Conflagration Excepted) — Steam 
Railroad Accidents and Injuries — Automobile Accidents 
and Injuries — ^Street Car Accidents and Injuries — In- 
juries by Other Vehicles — Traumatism by Machines — 
Acute Accidental Poisonings — Absorption of Deleterious 
Gases — Traumatism by Firearms — Industrial Fatal Acci- 
dents — Trend of the Accident Death Rate. 

h. Suicides : 

Suicide Mortality according to Color, Sex and Age 
Period — ^Suicide Death Rate among Insured Wage Earn- 
ers and Population of Expanding Registration Area 
Compared — Suicide according to Principal Means of 
Injury: Suicide by Poison — Suicide by Asphyxia — Sui- 
cide by Hanging or Strangulation — Suicide by Drown- 
ing — Suicide by Firearms. 

c. Homicides: 

Homicide, all Forms of Injury, by Color, Sex and Age 
Period — Homicide Mortality among Insured Wage Earn- 
ers and among General Population of Expanding Regis- 
tration Area — Trend of the Homicide Dearth Rate. 



CONTKNTS. Vll 

PAGE 

Chapter IX— Cancer 147-173 

-Certification of Cancer as a Cause of Death — Cancer Mortal- 
ity according to Organs or Parts Affected — Cancer Mortality 
according to Color, Sex and Age Period — Cancer among In- 
sured Wage Earners and among Population of Expanding 
Eegistration Area of United States Compared — ^Eolation of 
Cancer to Economic Condition^ — Trend of the Cancer Death. 
Rate — Detailed Mortality Statistics of Cancer according to 
Organs or Parts: Cancer of the Stomach and Liver — Cancer 
of the Female Genital Organs — ^Cancer of the Breast — Can- 
cer of the Peritoneum, Intestines and Eectum — Cancer of the 
Buccal Cavity — Cancer of the Skin — Cancer of Other Organs 
or of Organs not Specified. 

Chapter X — Cerebral Hemorrhage and Apoplexy 173-177 

Certification of Cerebral Hemorrhage and Apoplexy as a 
Cause of Death — Mortality according to Color, Sex and Age 
Period — 'Cerebral Hemorrhage among Insured Wage Earners 
and among Population of Expanding Eegistration Area Com- 
pared — Trend of the Death Eate, 

Chapter XI — Four Principal Communicable Diseases of 

Childhood 178-192 

Measles, Scarlet Fever, Whooping Cough, Diphtheria and 
Croup. 

Chapter XII — Diarrhea and Enteritis 193-196 

Diarrhea and Enteritis as Primary and Secondary Causesi 
of Death — ^Mortality according to Color, Sex and Age 
Period — ^Diarrhea and Enteritis Mortality among Insured 
Wage Earners and among General Population of Expanding 
Eegistration Area — Trend of the Death Eate from Diarrhea 
and Enteritis. 

Chapter XIII — Diseases and Conditions Incidental to 

the Maternal State 197-214 

Methods of Studying Maternal Mortality — ^Color and Age 
Incidence of Principal Causes of Maternal Mortality: All 
Puerperal Diseases and Conditions Combined — Puerperal 
Septicemia — Puerperal Albuminuria and Convulsions — Acci- 
dents of Pregnancy — Puerperal Hemorrhage — ' ' Other Acci- 
dents of Labor" — ^Maternal Mortality among Insured Fe- 
males and among Population of the Expanding Eegistration 
Area Compared: All Puerperal Diseases and Conditions — 
Puerperal Septicemia and Puerperal Albuminuria by Age. 

Chapter XIV — Diseases of the Arteries ; Typhoid Fever ; 

Cirrhosis of the Liver; Influenza; Diabetes .... 215-232 



Viii CONTENTS. 

PAGE 

Chapter XV — Appendicitis; Hernia, Intestinal Ob- 
struction; Syphilis; Chronic Bronchitis; Rheu- 
matism; Acute Bronchitis; Alcoholism, Acute 
and Chronic 333-248 

Chapter XVI — Pellagra; Malaria; Angina Pectoris; 

Ulcer of Stomach ; Acute Poliomyelitis 249-263 

Chapter XVII — Miscellaneous Diseases and Conditions 264-290 
Dysentery — Erysipelas — Purulent Infection and Septicemia 
— Gonocoeeus Infection — Anemia, Chlorosis — ' ' Other Chronic 
Poisonings" — Encephalitis — Meningitis — Cerebrospinal 
Fever — 'Locomotor Ataxia — Softening of the Brain — Oeneral 
Paralysis of the Insane — Convulsions — "Other Diseases of 
the Nervous System" — 'Diseases of the Ears' — Pericarditis — 
Acute Endocarditis — Embolism and Thrombosis — ^Diseases 
of the Xiarynx — Pulmonary Congestion, Pulmonary Apo- 
plexy — Asthma — ^" Other Diseases of the Eespiratory Sys- 
tem" — .Diseases of the Pharynx — "Other Diseases of the 
Stomach (Cancer Excepted)" — 'Biliary Calculi — "Other 
Diseases of the Liver" — Simple Peritonitis (Nonpuerperal) — 
Acute Nephritis — "Other Diseases of the Kidneys" — ^Dis- 
eases of the Bladder — Diseases of the Prostate — Uterine 
Tumor (Noncancerous) — "Other Diseases of the Uterus" — 
Salpingitis, Other Diseases of the Female Genital Organs — 
Gangrene — Old Age — Ill-Defined Diseases. 

Supplement 293-302 

Mortality Statistics of Insured Wage Earners, 1917. 

Appendix A 304-365 

Table Showing Number of Deaths from each Specified Dis- 
ease or Condition. Classified by Color, Sex, and by Age 
Groups. Period 1911 to 1916. 

Appendix B 366-376 

Table Showing Number of Deaths from each Specified Dis- 
ease or Condition, and Death Bates per 100,000 Exposed, 
for the Period 1911 to 1916, and for each Calendar Year. 

Appendix C 377-384 

Effect of System of Inquiry to Physicians upon Death Kates 
of Principal Diseases and Conditions; with Tables. 

Appendix D 385-387 

Standardized, or Corrected Death Kates. Metropolitan In- 
dustrial and United States Kegistration Area Death Kates, 
all Causes, Corrected on Basis of Standard Million of Popu- 
lation of England and "Wales, 1901. 

Index 389 et seq. 



MORTALITY STATISTICS OP INSUEED 
WAGE EARNERS AND THEIR FAMI- 
LIES IN THE UNITED STATES 
AND CANADA. 



CHAPTEE I. 



Inteoductoky. 

Public Health and Social Data of the Industrial Population. 

This report is presented as a contribution to the facts on the 
vitality of American wage earners. The great Metropolitan family 
of ten million policyholders is, more than any group for whom data 
are available, typical of our industrial population. The policy- 
holders are bound together by many ties which justify and add in- 
terest to a presentation of the facts of their mortality. This report 
is intended, however, to be more than a compilation of death rates. 
It is hoped that it will serve as a contribution to the public health 
and social welfare movements of recent years. The six year period 
covered by the report, 1911 to 1916 inclusive, is coincident with the 
period during which a wide programme of life conservation has been 
developed by the Company for its policyholders. Education in 
personal and civic hygiene, the care of the sick by visiting nurses 
and a number of other activities have been put into operation to 
improve the health of this large body of insured men, women and 
children. The facts which will be presented should, therefore, show 
what has been achieved through this programme and what still 
remains to be done in checking preventable sickness and premature 
death. Experience has proved that the ever broadening movement 
for life conservation must rest upon a firm foundation of well 
established facts. 

Area Covered hy These Data. 
These data are of interest and value to public health and social 
workers because they are comprehensive. They relate to an area 
2 1 



2 MORTALITY STATISTICS OF INSURED WAGE EARNERS. 

which includes nearly all the states of the United States and the 
provinces of Canada. The statistics, therefore, reflect the sanitary 
and social conditions prevailing throughout the industrial popula- 
tion of two great national units. The only states not included in 
this experience are Mississippi, North and South Dakota, Wyom- 
ing, Colorado, Texas, Nevada, Arizona and New Mexico. It should 
be remembered that even in these states reside a considerable num- 
ber of policyholders who transact their business by correspondence 
with the Home Office of the Company in New York City. It may 
be said, therefore, that the figures are truly representative of the 
entire wage earning population of the United States and Canada. 
The geographic range of the data is much broader than that of the 
Eegistration Area established by the United States Bureau of the 
Census for the collection of mortality statistics of the general popu- 
lation of the United States. A large proportion of the insured 
wage earners reside in the so-called non-registration area and the 
facts for them will be included in our compilation. The im- 
portance of this will be brought out in some detail in the discussion 
of some diseases and conditions whose incidence is confined very 
largely to certain sections of the country where state-wide registra- 
tion of mortality does not as yet exist. In fact, the data for insured 
wage earners presented herein will for some time remain the only 
authentic compilation of mortality for these areas. 

Wide Range of Occupations among Insured Wage Earners. 
The facts presented in this report are unique also because they 
present for the first time a connected and detailed analysis of the 
facts of mortality among the industrial workers of the country. 
All the important industries and occupations are represented. 
Laborers form the largest single group, followed by teamsters, 
drivers and chauffeurs, by machinists, by textile mill operatives, by 
clerks and office assistants in the order named. In fact, all the 
more skilled industrial workers are represented, and in a proportion 
not very different from that found among occupied persons in the 
general population. The diversity of occupations among white 
males in this mortality experience will be seen by referring to 
page 87, of Bulletin 207, United States Bureau of Labor Statistics, 
March, 1917. This document displays the occupational mortality 
experience of the Industrial Department of this Company, accord- 
ing to principal causes of death. 



INTEODUCTOET. 3 

Women and Children in Wage Earners' Families. 

The members of wage earners' families are also accounted for in 
good measure in this collection of data. A very large proportion of 
the total number of persons observed are the wives and children of 
wage workers. In this respect, it is believed that this study pre- 
sents for the first time a discussion of the facts of mortality among 
women and children of the wage earning groups of the American 
population. We shall see later in our discussion of the age char- 
acteristics of this group of insured persons that a fairly close corre- 
spondence with the age distribution of the general population is 
maintained for a considerable span of life. 

Although all the statistics which follow include the women and 
children in wage earners' families, reference is usually made to the 
group as that of insured wage earners, the full title being thus 
abbreviated for simplicity. 

Mortality Data of the White and Colored Races. 

The facts also display the mortality characteristics of both the 
white a-nd colored races among the insured wage earning popula- 
tion. These facts of comparative mortality, considered according 
to sex and age, are practically unavailable in any official vital sta- 
tistics for the general population. Such comparisons between the 
mortality of the white and colored races as do exist have been based 
upon figures which included all classes of the white population on 
the one hand and all classes of the colored population on the other. 
For purposes of determining race characteristics of mortality, these 
comparisons are invalid because of the sharply different environ- 
mental circumstances of the groups. The colored race in the United 
States, especially in urban centers of population, suffers sanitary 
and other social disabilities which must be discounted before fair 
comparisons of colored with white mortality can be made. When 
the statistics of white and colored wage earners are compared, how- 
ever, much of the objection to the usual figures for white and 
colored mortality is removed. The insurance data have the further 
advantage that the number of colored persons is large, covering all 
urban areas in the North as well as in the South. The data are 
also representative of both sexes and of all ages of colored persons 
exclusive of infants. 



4 MORTALITY STATISTICS OF INSUEED WAGE EAENEKS. 

Number and Composition of the Insured Group as to Color, Sex 

and Age. 

This widely distributed and representative group of wag« earners 
contributed very nearly 54,000,000 years of life for observation in 
the mortality experience of the period 1911 to 1916. Of this num- 
ber, more than 47,000,000 years of life, or 87.5%, pertained to 
white policyholders and nearly 6,700,000, or 13.5%, to colored pol- 
icyholders. It is evident that there was a sufficient number of 
lives exposed in this inquiry to warrant drawing reliable conclu- 
sions. This mass of data, considered in relation to its wide geo- 
graphic distribution, its special application to the wage earning 
group of the population, its substantial characteristics as to color, 
sex and age classes, and the completeness of the registration of the 
facts is, in our opinion, unparalleled in the history of American 
vital statistics. 

The following table gives the color and sex characteristics of the 

data: 

TABLE 1. 

Number and Percentage op Policyholj)ers 1911 to 1916, Classified 

BY Color and by Sex. 

Experience of Metropolitan Life Insurance Company. Industrial 
Department. 



Color and Sex. 


Number. 


Percentage. 


Total 


53,796,547* 


100.0 


White 


47,098,458 


87.5 


Male 


21,389,717 
25,708,741 

6,698,089 


39.8 


Female 


47.8 


Colored 


12.5 


Male ' 


3,051,956 
3,646,133 


5.7 


Female 


6.8 







* strictly speaking these represent years of life exposed during the six 
year period and not so many different persons. The method employed to 
obtain this figure from the number of policies in force will be explained 
on page 8. 



Very nearly one-half of the total, (47.8 per cent.) were white 
females. The proportions of the white and the colored, respectively, 
in this group of policyholders, are different from those found in 
the general population of the Eegistration Area for deaths in the 



INTRODUCTORY, O 

United States. The proportion of negroes represented in this in- 
vestigation is nearly three times that found in the expanding Eeg- 
istration Area of the United States. For the latter area, over the 
period 1910 to 1915, 4.6 per cent, of the total estimated population 
was of negro extraction. This variation in our data is due pri- 
marily to the choice of localities in which the Company conducts 
industrial life insurance business. It has been thought desirable, 
therefore, to confine our comparisons in the later sections of this 
report to specific race, sex and age classes and not to discuss to 
any great extent the aggregate results of both white and colored 
mortality experiences. 

Age Constitution of the Insurance Experience. 

The age composition of the group of policyholders observed in 
this mortality investigation is also of interest, especially when it is 
desired to make comparison of our data with those for the general 
population. In the following table we present a comparison of the 



TABLE 2. 
Pbrcentagk Distribution of Estimated Number of 
Classified by Age Period for each Sex, 



Policyholders 



Metropolitan Life Insurance Company, Industrial Department, 1911 to 1916, 

and Estimated Population of Expanding Registration Area of the 

United States, 1910 to 1915. 





Males. 


Females. 


Age Period. 


M. L. I. Co., 
1911 to 1916. 


Reg. Area, 
1910 to 1915. 


M. L.I. Co., 
1911 to 1916. 


Reg. Area. 
1910 to 1915. 


All ages — one and over 


100.00 


100.00 


100.00 


100.00 


1 to 4 

5 to 9 

10 to 14 

15 to 19 

20 to 24 

25 to 34 

35 to 44 

45 to 54 

55 to 64 

65 to 74 

75. and over .... 


9.35 

15.05 

13.62 

12.30 

10.14 

14.55 

10.18 

7.37 

4.95 

2.15 

.32 


8.30 

9.45 

9.05 

9.38 

10.12 

18.15 

14.49 

10.34 

6.07 

3.33 

1.33 


7.59 

12.27 

11.05 

10.43 

10.11 

16.72 

12.80 

9.53 

6.29 

2.78 

.44 


8.57 

9.82 

9.45 

9.98 

10.27 

17.33 

13.81 

9.72 

5.96 

3.53 

1.57 



percentage of policyholders and of estimated population in the 
several age classes. The matter of color distinction is not of basic 
importance in this discussion of age distribution and the data are 



MORTALITY STATISTICS OF INSURED WAGE EAENEES. 



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INTEODUCTOEY. 7 

accordingly presented, in this particular instance, by sex only, for 
all classes of insured persons combined and for all race groups of 
the general population in the Eegistration Area of the United 
States. 

Comparisons are confined to ages one year and over because no 
children under one year of age are included in the insurance ex- 
perience. In the foregoing table we find a considerably larger bulk 
of both males and females under twenty years of age in the insur- 
ance experience than in the general population experience. In the 
population group, we find a slightly greater representation of women 
at the child-bearing ages than among the insured females. The 
main working period of life contains a larger representation of 
males of the general population than of males in the insured group. 

The graph on page 6 shows the tendency of the population group 
to bulk more heavily in the later ages of life. Together with Table 
2, it emphasizes the necessity for considering age and sex distinc- 
tions in analyzing the experience of the two groups. Comparisons 
between the population and insurance experience can be made with 
safety only when the higher average age of the population group is 
discounted by confining such comparisons strictly to similar age 
and sex classes. 

Composition with Respect to Other Factors. 
The composition of the group of policyholders with respect to 
nativity, parentage and other factors which materially affect a mor- 
tality experience, is also different for this group of insured wage 
earners than for the general population. There are no figures 
available at the present time to indicate thp precise proportions of 
native and foreign born persons nor of the number of persons of 
the several foreign white race stocks among the insured. It is not 
possible, therefore, to say how much our figures are affected by the 
single factor of nationality or by the racial mortality characteristics 
of the foreign white stocks in our experience. It should be borne 
in mind that these policyholders reside almost altogether in cities 
and towns and therefore have all the characteristics of an urban 
population. 

Technical Processes of Compiling the Data. 
The foregoing comment has described briefly the broader charac- 
teristics of our data — their scope and application to the study of 



8 MORTALITY STATISTICS OF INSURED WAGE EARNERS. 

the public health problems affecting the wage earning population. 
In order better to understand the exposition of the detailed data 
in the report, it will be well to view in summary the chief tech- 
nical processes employed. 

Estimating the Number of Policyholders Exposed to Risk-. 
The registers of an industrial life insurance company do not 
show the number of separate persons exposed to risk. The ac- 
counts of mortality are in everyday actuarial practice related only 
to the policy exposure. Industrial insurance medical statistics, 
however, require that a reliable estimate of the number of separate 
persons, or the years of life exposed, be prepared. We may say 
briefly that this estimate of the number of years of life exposed to 
risk according to the several color, sex and age classes of the data 
was prepared on the assumption that the ratio in each of these 
classes of the number of claims paid to the number of decedents in- 
volved in these claims was the same as the number of policies out- 
standing to the number of lives insured. From the tabulation of 
the number of deaths and the number of claims according to color, 
sex and age classes these ratios were prepared. They were applied 
to the mean numbers of policies outstanding in each of the calendar 
years of this experience and the number of years of life exposed 
to risk was thus estimated for the entire six-year experience. 

Classifying and Tabulating the Data for Deaths. 

The preparation of the data from the primary records of the 
claims paid in the Industrial Department involved a number of 
technical processes. The accuracy and planning of these matters 
of office practice have an important l>earing upon the value of the 
conclusions to be drawn from the tabular material displayed in this 
report. A brief discussion of these processes follows: 

All of the necessary records in connection with each claim were 
examined and the items which it was desired to consider in the 
tabulation of the statistics were abstracted upon so-called "tran- 
script sheets," each line containing the necessary information for 
a single claim. Some of the facts, such as age, amount of 
insurance and other strictly numerical data, were directly copied 
upon the line corresponding to the particular claim document. 
Other items such as the disease causing death, the occupation, place 
of birth, etc., were first classified in terms of numerical symbols 



INTKODUCTORT. 9 

and then copied upon the transcript sheets. The final product of 
this transcribing and classification process, for each claim, is a 
single line of numerical symbols, the meaning of which can be in- 
terpreted according to a previously arranged coding system. Ages 
were recorded in this investigation according to the age at the 
nearest birthday. The symbols for color and sex of the deceased 
presented no problems worthy of mention. The diseases causing 
death and the occupations of the deceased, however, were classified 
only through the exercise of extreme care in the examination of 
the claim papers and only after the full requirements of standard 
systems of nomenclature and classification in each of these chief 
subjects had been complied with. 

Classification of Diseases Causing Death 
The system of nomenclature and classification employed in arriv- 
ing at numerical designations for use in this analysis of wage 
earners' mortality experience was the excellent " International List 
of Causes of Death." The requirements of this well known and 
widely accepted system of preparing statistical data of diseases 
were followed out in every important respect. Where two or more 
diseases or conditions were reported by physicians on the death 
certificate, assignment of the death to one particular disease or 
condition was made according to the rules laid down in the Classi- 
fication Manual and to certain general rules of selective classifica- 
tion procedure authorized by the United States Bureau of the Cen- 
sus, Division of Vital Statistics. 

Classification of Occupations. 
Occupations of deceased persons were recorded generally in satis- 
factory detail upon the Company's forms for the reporting' of deaths. 
This permitted us to compile fairly precise information on the oc- 
cupational aspects of this mortality experience. The occupations 
were classified in accordance with the rulings of the " Classified 
Index to Occupations" issued by the United States Bureau of the 
Census in 1910. The full list of occupation titles given in this 
official index was not used. The list of titles was in fact limited 
to a certain number of occupations in the leading industries which 
were of interest either because of the number of deaths reported 
in them annually, or because of some special feature of hazard or 
hygiene. It is believed that much time and unnecessary work were 



10 MOETALITY STATISTICS OF INSURED WAGE EARNERS. 

thus saved in the tabulation and interpretation of the material. 
No detailed occupation data are given in this report, but the full 
account of the mortality experience of the Industrial Department 
of this Company according to the occupations of deceased persons 
over the years 1911 to 1913 was rendered in Bulletin No. 207 of 
the United States Bureau of Labor Statistics quoted in another 
section of this report. 

Tabulating the Data from Perforated Cards. 

The material of this study was tabulated by machine processes 
which necessitated the use of perforated tabulating cards. It is 
necessary to say only that the information on each claim was trans- 
ferred from the transcript sheets mentioned above to the tabula- 
ting cards by means of Hollerith Punching Machines. For pur- 
poses of accuracy the information on each claim was perforated in 
duplicate, first upon a buff card, then upon a red card. The buff 
and red cards for each claim were perforated by different operators. 
The buff card for each claim was checked against the corresponding 
red card by holding both cards against an illuminated glass plate. 
When discrepancies were revealed, reference to the line on the tran- 
script sheet covering the case showed which card was correct. This 
process insured the accurate transfer of the facts from the transcript 
sheets to the tabulating cards. 

The first process in the tabulation of the data was to identify 
the deaths in the experience separately from the claims. Often 
more than one claim was reported for one death; that is, in cases 
where the insured carried a number of policies on his or her life. 
The extra or secondary claims were designated by a distinguishing 
symbol which made it possible to sort out those cards which corre- 
sponded to deaths only. It was further decided to confine this in- 
vestigation to the so-called " premium-paying business " of the In- 
dustrial Department. This excluded a small proportion of the ex- 
perience on the lives of persons who were insured on a " paid-up ^' or 
similar basis. The reason for this will be made clearer as we pro- 
ceed, but at this point it may be said that sufficiently detailed in- 
formation with regard to the age, sex and color of these " paid-up " 
policyholders is not at hand. On the other hand, information with 
regard to the living premium-paying policyholders is especially 
complete, making possible the most detailed comparisons of the 
living and of the deceased policyholders. 



CHAPTEE II. 

MOKTALITT FEOM AlL CaUSES OF DeATH COMBINED. 

In this section we shall consider in some detail the total mortal- 
ity of the insured group, that is, without distinction of the indi- 
vidual causes of death. We shall comment also upon the death 
rates for the several color, sex and age classes. Later we shall con- 
sider the special factors which we believe influence more or less the 
general mortality experience of those insured in an industrial life 
insurance company. 

Deaths according to Color, Sex and Age. 

A total of 635,449 deaths is represented in this experience for 
the calendar years 1911 to 1916 inclusive. Of this number 520,079 
deaths were of white persons and 115,370 were deaths of colored 
persons. The following table gives a view of the color and sex 
composition of the deaths : 

TABLE 3. 
Number and Percentage of Deaths, Classified by 'Color and by Sex. 
Experience of Metropolitan Life Insurance Company. Industrial Depart- 
ment. 1911 to 1916. 



Color and Sex. 


Number of Deaths. 


Percentage. 


Total 


635,449 


100.0 


White 


520,079 


81.8 






Male 


252,742 
267,337 

115,370 


39.8 


Female 


42.1 


Colored 


18.2 


Male 


53,795 
61,575 


8.5 


Female 


9.7 







It will be seen that a little more than four-fifths of the deaths 
were of white persons. Colored deaths were recorded in 18.2% of 
the total cases. Since only 12.5% of the number of persons ex- 
posed were colored, this higher representation of colored persons 

11 



12 



MORTALITY STATISTICS OF INSURED WAGE EARNERS. 



in the total of deaths indicates the higher death rate of that group 
of policyholders. For both white and colored persons there were 
more female than male deaths. This is accounted for by the fact 
that there is a larger proportion of females than males in the ex- 
posure. The significance of these several relations will be clearer 
when we proceed to relate the deaths to the number of living, that 
is, when we compare the death rates per 1,000 persons exposed in 
each class. 

Age Composition of the Deaths. 

It will be of interest to inquire also into the age composition* of 
the deaths recorded in this aggregate experience for the period 1911 
to 1916. No deaths of persons under one year of age were in- 
cluded. Among the 635,449 deaths at ages one year and over, 
58,009 or 9.1%, were between the ages of one and four jesLvs. 
Slightly more than one-fifth of the deaths (20.1%) occurred under 
the age of 20. Between the ages 20 and 64 years, the main work- 
ing period of life, 60.1% of the deaths occurred. For the ages 65 
and over there were recorded 19.7%, or just under one-fifth of 
the total. In other words, there was approximately the same pro- 
portion of deaths at the ages 65 and over as at the group of ages 
under 20 years. The foregoing facts are displayed in the follow- 
ing table: 

TABLE 4. 
Number axd Percentage of Deaths Classified by Age Period. 
Experience of Metropolitan Life Insurance Company. Industrial Depart- 
ment. 1911 to 1916. 



Age Period. 


Number. 


Percentage. 


All ages — one and over 


635,449 


100.0 


1 to 4 


58,009 
26,645 
16.606 
26,655 
35,027 
73,429 
80,152 
87,734 
105,673 
97,361 
28,158 


9 1 


5 to 9 


4 2 


10 to 14 


2 6 


15 to 19 


4 2 


20 to 24 


5 5 


25 to 34 


11 6 


35 to 44 


12 6 


45 to 54 


13 8 


55 to 64 


16 6 


65 to 74 


15 3 


75 and over 


4.4 



* Ages of deceased persons were classified according to age nearest birth- 
day. The age period 5 to 9 years, for instance, ranges from average ag« 
44 to average age 9i years. 



MORTALITY FROM ALL CAUSES, 



13 



Death Rates per 1,000 Persons Exposed for the Entire Experience. 

The 635,449 deaths reported during the six year period 1911 to 
1916 represented a death rate of 11.81 per 1,000 exposed. Among 
the entire group of white persons the death rate was 11.04 per 1,000 
and among colored lives, 17.32 per 1,000 exposed. This excess of 
practically one-half in the colored death rate will be treated analyt- 
ically from various angles in the following text. The causes of 
death responsible for the larger part of this excessive mortality 
among colored persons, with especial comment upon the age and 
sex characteristics of the experience, will also be duly taken up. 
The following table gives a comparative view of the death rates per 
1,000 persons exposed for each of the color and sex classes of this 
mortality experience for the entire period 1911 to 1916 : 



TABLE 5. 

Deaths, and Death Bates Per 1,000 Persons Exposed. All Causes of 
Death Combined. Classified by Color and by Sex. 

Experience of Metropolitan Life Insurance Company. Industrial Depart- 
ment. 1911 to 1916. 



Color and Sex. 


Number of Deaths. 


Death Rates per 1,000 
Exposed. 


Total 


635,449 


11.81 






White 


520,079 


11.04 






Males 


252,742 
267,337 

115,370 


11.82 


Females 


10.40 


Colored 


17.22 






Males 


53,795 
61,575 


17.63 


Females 


16.89 







Considering only all ages in this experience combined, white 
females show the most favorable mortality record, followed by white 
males and colored females, with colored males exhibiting the highest 
death rate in this present mortality study of insured wage earners. 
More detailed comment upon these differences in mortality will be 
given in the following section on the age characteristics of mortality 
among insured wage earners. 



14 



MOKTALITT STATISTICS OF INSURED WAGE EARNERS. 



Deaths and death rates by color, sex and age period. All causes of 

death combined. 

The preceding table, giving the death rates per 1,000 persons ex- 
posed for each of the color and sex classes, is indeed too broad in 
its scope to warrant our drawing any conclusions on the differences 
in mortality of the several color and sex classes. A conclusion of 
this kind can be drawn only after an examination of the death 
rates for each of the color and sex classes, properly grouped accord- 
ing to ages. The following table gives the facts of mortality accord- 
ing to age period in this experience for insured wage earners : 

TABLE 6. 

Mortality peom All Causes of Death Combined, Classified by Color, 

Sex and by Age Period. 

Death Bates Per 1,000 Persons Exposed. 1911 to 1916. 

Experience of Metropolitan Life Insurance Company. Industrial 

Department. 





Persons. 


White. 


Colored. 


Age Period. 


Males. 


Females. 


Males. 


Females. 


All ages — one and 
over 


11.81 


11.82 


10.40 


17.63 


16.89 






lto4 

5 to 9 

10 to 14 

15 to 19 

20 to 24 

25 to 34 

35 to 44 

45 to 54 

55 to 64 

65 to 74 

75 and over . . . 


12.86 

3.66 

2.53 

4.39 

6.43 

8.67 

12.83 

19.08 

34.56 

72.53 

135.21 


12.69 

3.64 

2.32 

3.76 

5.97 

9.24 

15.90 

23.64 

40.03 

79.68 

145.13 


11.75 

3.33 

2.16 

3.58 

5.27 

6.70 

9.23 

14.37 

28.98 

66.91 

129.16 


21.79 

5.42 

4.65 

9.32 

12.04 

14.23 

19.20 

27.64 

46.91 

84.21 

137.61 


20.77 

5.64 

5.72 

11.36 

12.57 

12.36 

16.14 

24.12 

40.17 

73.39 

135.74 



We shall discuss first the variation in the death rate from one age 
period to another for the total mortality experience. The age series 
of death rates shows a high mortality rate at the outset, beginning 
with the age period 1 to 4 years, followed by a sharp decline to a 
minimum for the age period 10 to 14 years. In most mortality 
investigations, the minimum death rates at any age period in life 
are usually to be found between 10 and 14 years of age. There- 
after, there occurs a gradually rising death rate up to the highest 
age period in the series. Not until we reach the age group 35 



MORTALITY FEOM ALL CAUSES. 15 

to 44 years do we find the mortality rate approximately as high, 
12.83 per 1,000 persons exposed, as it was at the outset of this 
series. The rate rises in the next ten year divisional period of life 
to a figure of 19.08 per 1,000 and in the succeeding ten year period 
to a rate of 34.56 per 1,000. The highest significant age group in 
this study, 65 to 74 years, shows a rate of 72.53 per 1,000 persons 
exposed. In this report we shall not place much emphasis upon our 
figures for the age group 75 years and over, because of the unusual 
composition of the group as to the ages of the persons included in 
it. For white males in this mortality experience we find the same 
point of minimum incidence of mortality as was observed for the 
total experience. In adult life however the rise in the curve of 
mortality among white males is very much sharper than for the 
total experience. White females in this mortality investigation 
show a much more gradual upward slope of the mortality curve in 
adult life, in contrast to the sharpness of the upward trend of mor- 
tality among white males at the later adult ages. It should be 
noted that for colored females the minimum mortality rate is found 
between 5 and 9 years and not between 10 and 14 years as was the 
case for the other three main classes in this mortality study. We 
shall now consider a few comparative ratios of mortality between 
the white and colored races according to sex and between the two 
sexes within each color or race group. 

Ratios of Mortality of White and Colored Races hy Age Period. 

a. White Male and Colored Male Death Rates Compared. 

Considering all ages of the mortality experience of males, the 
colored show a mortality rate nearly fifty per cent, higher than that 
of the white race. The ratio of colored to white male mortality 
varies decidedly with the several age periods. In the ages of early 
adolescence, fifteen to nineteen years, colored male mortality shows 
its greatest ratio of excess over white male mortality. The col- 
ored male death rate, at this age period, is practically 250 per cent, 
of the rate for white males. Between five and twenty years of age, 
for each five year period, there is an increment of practically fifty 
per cent, in the excess of colored male over white male mortality. 
Between five and nine years, the excess of mortality was prac- 
tically fifty per cent., between ten and fourteen years, one hundred 
per cent., and between fifteen and nineteen years, one hundred 



16 



MOETALITY STATISTICS OF INSUKED WAGE EARNERS. 



and fifty per cent. Beginning with the age period twenty to 
twenty-four years, there is a gradual decline in this excess of col- 
ored male over white male mortality. The only exception is the 
age period fifty-five to sixty-four years, which shows a practically 
stationary ratio of excess mortality, with respect to the preceding 
age period forty-five to fifty-four years. After these two age 
periods, the rate of colored male mortality does not differ greatly 
from that for white males. The following table displays the ratios 
of white and colored mortality for males : 



TABLE 7. 

MOETALITY FROM AlL CAUSES OP DEATH COMBINED. WHITE MALES AND 

Colored Males Compared. 

Beath Bates Per 1,000 Persons Exposed. 1911 to 1916. 

Experience of Metropolitan Life Insurance Company. Industrial 

Department. 









Percentage Colored 


Age Period. 


White Males. 


Colored Males. 


of White Rate. 


AH ages — one and over . 


1L82 


17.63 


149.2 


1 to 4 


12.69 
3.64 
2.32 


21.79 

5.42 
4.65 


171.7 


5 to 9 


148.9 


10 to 14 


200.4 


15tol9 


3.76 


9.32 


247.9 


20 to 24 


5.97 


12.04 


201.7 


25 to 34 


9.24 


14.23 


154.0 


35 to 44 


15.90 


19.20 


120.8 


45 to 54 


23.64 


27.64 


116.9 


55 to 64 


40.03 


46.91 


117.2 


65 to 74 


79.68 


84.21 


105.7 


75 and over 


145.13 


137.61 


94.8 



The reduction of these comparative figures to graphic form brings 
out a number of interesting characteristics of the mortality of the 
two races. The curve of the death rates of white male mortality, 
for instance, is continuously concave throughout. The colored 
male curve, between central age 13.5 years and central age thirty 
years, shows a somewhat convex form. The high death rate from 
pulmonary tuberculosis is the chief influence at work to produce 
this significant difference in the contour of the colored mortality 
curve. The chief item of interest in the graphic illustration (on 
page 17) of these two curves is the general tendency of mortality 
among colored males to approach mortality among white males at 
the advanced ages. 



MORTALITY FEOM ALL CAUSES. 



17 



Chart li. — Pi/!ortaeity from All Causes of Death 

Death R&tes per 1,000 Persons Exposed. CtassEfied by Age Periods. White 
Males and Colored Males Compared 

Cxperlsnce of Metropolitan Life Insurance Company, Industrial Department, 1S11 to 1916 

D'ceth Rste 
per t.OOO 



'' 1 

AO 1 














1 

1 

1 
1 

( 






















ii 

i 




















' 1 

n 
il 










Cohrt 












i 1 

I 

I 




f 


















n 






















1 / 






















1 


/ 




















1 

1 




























// 


/ 








V 










> 


/ 






i 
1 




y^ 






.^ 




/ 














\\ 






^ 




/^ 














\ 




/ 


^ 
















O 






















i 



/-<' .r-f yff-y-f /s-jg xo-n Af-J« A7'«4 «f-.r* 

AGE PERIOD 



18 



MORTALITY STATISTICS OF INSUKED WAGE EAENERS. 



b. White Female and Colored Female Death Rates Compared. 

For all ages combined, the mortality among colored females was 
very nearly two-thirds in excess of the mortality among white 
females. The ratio of excess varied with age period. The point 
of maximum excess in colored female over white female mortality 
occurred in the age period fifteen to nineteen years — the period of 
adolescence. The rate for colored females was then more than 
three times as high as for white females (317.3%). In fact, the 
tendency of the colored mortality rate to diverge from the white 
mortality rate was more marked for females than for males at every 
age period of life. The following table displays the figures of 
comparative mortality of white and colored females: 



TABLE 8. 

MOETALITY FEOM ALL CAUSES OF DEATH COMBINED. WHITE FEMALES AND 

Colored Females Compared. 

Death Bates Per 1,000 Persons Exposed. 1911 to 1916. 

Experience of Metropolitan Life Insurance Company. Industrial 

Department. 









Percentage, Colored of 


Age Period. 


White I'emales. 


Colored Females. 


White Rate. 


AU ages — one and over . 


10.40 


16.89 


162.4 


1 to4 


11.75 
3.33 
2.16 


20.77 
5.64 
5.72 


176 8 


5 to9. . . 


169 4 


10 to 14 


264.8 


15 to 19 


3.58 


11.36 


317.3 


20 to 24 


5.27 


12.57 


238.5 


25 to 34 


6.70 


12.36 


184.5 


35 to 44 


9.23 


16.14 


174.9 


45 to 54 


14.37 


24.12 


167.8 


55 to 64 


28.98 


40.17 


138.6 


65 to 74 


66.91 


73.39 


109.7 


75 and over 


129.16 


135.74 


105.1 



The contour of the mortality curve for colored females shows de- 
cidedly more profound disturbance between central age 13.5 years 
and central age 30 years than did the curve for colored males. The 
white female curve shows a slightly convex tendency between these 
two central ages. It will be recalled that the white male curve 
was concave throughout. Furthermore, the colored female curve 
is emphatically more convex between central ages 12.5 years and 
30 years than the colored male curve between these limits. It will 



MORTALITY FROM ALL CAUSES. 



19 



Chart !I9.^ Mortality from Ail Causes of Death 

Death Rates per 1,000 Persons Exposed. Classified by Ago Periods. Whlt« 

Females and Colored Females Compared 
Experience o1 Metropolitan Life Insurance Company, industrial Department, 1911 to 1916 




J-9 19-14 *S-19 20-Z4 £S-J* JS-4* 

AGE PERIOD 



20 MOKTALITY STATISTICS OF INSURED WAGE EAENEES. 

be pointed out in a later section just how much of this deforma- 
tion in the mortality curve for colored males is due to tuberculosis, 
and for colored females to tuberculosis and the diseases and condi- 
tions incidental to the gravid and puerperal states. 

The graphic illustration on page 19 gives a convenient view of the 
course of white and colored mortality throughout the various age 
periods for females. 

The reader will be inclined to speculate upon the disproportion 
between the ratio of white and colored female mortality and the 
ratio of white and colored male mortality. It would seem, oifhand, 
from the standpoint of comparative mortality, that colored females 
were by far the worse off. It must be remembered, however, that 
white male mortality bears a much more unfavorable relation to the 
total white mortality than does colored male mortality to tlie total 
mortality of colored lives. This situation should be borne in mind 
in drawing conclusions from a comparison of white and colored 
mortality according to sex. It will be of interest and profit, there- 
fore, to view briejfly the ratio of mortality according to sex within 
each color class. 

Ratios of Mortality of Males and Females hy Age Period. 

For all ages combined, white male mortality Avas about fourteen 
per cent, in excess of white female mortality. This ratio was not 
constant, however, for the several age periods. Below twenty years 
of age, the excess of white male over white female mortality was 
never less than five nor more than ten per cent. Beginning with 
the age period twenty to twenty-four years, with its central age at 
22.5 years, the excess of white male over white female mortality 
began to assume considerable proportions. In this age period, 
when white males begin to take up the arduous and toilsome labor 
of the great mass of the male wage earning population, white male 
mortality was over thirteen per cent, in excess of white female mor- 
tality. Between twenty-five and thirty-four years, with the central 
age at thirty years, white males showed a mortality rate thirty-eight 
per cent, in excess of the rate for white females. Between thirty- 
five and forty-four ye^rs, with the central age at forty years, we 
find the maximum point of excess in the mortality of white males 
over that of white females, namely, over seventy-two per cent. The 
relative excess of white male mortality begins to decline after that 



MORTALITY FROM ALL CAUSES. 



21 



age period, but thereafter never approaches the figure for white 
female mortality nearer than twelve per cent, and that at the 
highest significant age period in this study. We shall see later that 
tuberculosis and accidents account for a very large part of this 
excess of white male over white female mortality. 

As already suggested, the ratios of male and female mortality 
among colored lives present an emphatically different picture than 
do the ratios for white lives. Colored male mortality at any age 
period is never in excess of colored female mortality by more than 
twenty per cent. The range of life between central age 7.5 years 
and central age 22.5 years shows decidedly more favorable mor- 
tality among colored males than among colored females. Between 
ten and fourteen years, colored male mortality is nineteen per cent, 
more favorable than colored female mortality. The particular 
causes of death responsible for this favorable showing among 
colored males will be pointed out in succeeding parts of this report. 
Colored male mortality is in excess by nearly twenty per cent., the 
maximum ratio of excess, in the age period thirty-five to forty-four 
years. The following table gives a comparison of the sex ratios 
of mortality for the white and colored races: 

TABLE 9. 

Percentage. Male of Female Death Bates Classified by Color and bt 

Age Period. 

Experience of Metropolitan Life Insurance Company. Industrial Depart- 
ment. 1911 to 1916. 



Age Period. 


White. 


Colored. 


All ages — one and over 


113.7 


104.4 


1 to 4 


108.0 
109.3 
107.4 
105.0 
113.3 
137.9 
172.3 
164.5 
138.1 
119.1 
112.4 


104.9 


5 to 9 


96.1 


10 to 14 


81.3 


15 to 19 


82.0 


20 to 24 


95.8 


25 to 34 


115.1 


35 to 44 


119.0 


45 to 54 


114.6 


55 to 64 


116.8 


65 to 74 


114.7 


75 and over 


101.4 







We may conclude, then, with the following general comment: 
among white persons the mortality rate of males is always in 



22 MOKTALITY STATISTICS OF INSURED WAGE EAENEES. 

excess of that of females. This excess is least marked below 
age 25 and above 75, but not inconsiderable even at these ages. At 
the point of greatest difference, namely, at the age period 35 to 
44 years, the male rate is nearly three-fourths in excess. Among 
colored persons, the picture is different in a number of essential 
respects. The male rate is lower than the female rate under age 
25, with the single exception of children of one to four years. 
After 75 years the two rates are much the same. The actual death 
rate between 25 and 75 years is higher for colored males than 
females, but the excess is altogether moderate as compared with 
what we have noted among white lives. 

Comparison of Death Rates per 1,000 exposed. White Persons in 

Insurance Experience, 1911 to 1916, and General Population 

of Expanding Registration Area, 1910 to 1915. 

The mortality experience of insured wage earners, 1911 to 1916, 
may now be compared profitably with that for the general popula- 
tion of the expanding Eegistration Area of the United States, 1910 
to 1915. A number of limitations to the completeness of this com- 
parison must first be pointed out. We must make the comparison 
in the first place between the experience of white insured lives on 
the one hand and the total population, white and colored, of the 
expanding Registration Area, on the other. This is because the 
white insurance experience is most like that of the Eegistration 
Area from which the small proportion of colored cannot accurately 
be eliminated. The proportion of colored persons in the insurance 
experience for 1911 to 1916 (12.5%) is large and affects the total 
Metropolitan death rate too much to permit a comparison with the 
rate of the total Eegistration Area, with its very much smaller pro- 
portion of colored lives. It must be remembered also that at the 
time this comparison is being made there are available for the Eeg- 
istration Area only the data for the years 1910 to 1915 according 
to sex and age period. This constitutes a six-year period not very 
different from the period 1911 to 1916 for which the insurance data 
are at hand. There are. other differences- of area, occupational com- 
position, etc., to which, reference has already been made. But all 
considered, the differences in the figures which we shall point out 
fairly represent a true difference in the vitality of the two groups. 

The annual reports of the United States Bureau of the Census on 



MOKTALITY FEOM ALL CAUSES. 



23 



mortality statistics for the years 1910 to 1915 give tables showing 
the number of deaths classified by sex and age period and for each 
of the diseases or causes of death in the International List. There 
is, however, no corresponding record giving an official estimate of 
the populations exposed to risk in the Registration Area at the sev- 
eral age periods and by sex. In order to compute death rates it 
is necessary first, to estimate such population exposure. This was 
obtained by combining the estimated populations for each sex and 
age class in the expanding Registration Area for each year from 
1910 to 1915 inclusive. Our thanks are due to Dr. F. L. Hoffman, 
Third Vice-President and Statistician of the Prudential Insurance 
Company of America, who placed at our disposal these estimates of 
population. 

The following tables show the death rates per 1,000 living, for 
each of the sexes, in the Registration Area, 1910 to 1915, and a 
comparison with similar data for insured white males and females : 

TABLE 10. 

MOETALITY FEOM ALL CAUSES OF DEATH. 

Death Bates Per 1,000 Persons Exposed. Classified by Sex and hy Age 
Period. White Lives in Experience of Metropolitan Life Insurance 
Company, Industrial Dept., 1911 to 1916, and Estimated Gen- 
eral Population of Expamding Eegistration Area, 
United States, 1910 to 1915. 





Males. 


Females. 


Age Period. 


M. L. I. Co. 
(White). 


U. S. Reg. 
Area. 


Percentage 
M. L.I. Co. 
of Reg. Area. 


M. L. I. Co. 
(White). 


U. S. Reg. 
Area. 


Percentage 
M. L. I. Co. 
of Reg. Area. 


AH ages — one 
and over 


11.82 


12.41 


95.2 


10.40 


11.08 


93.9 


lto4 


12.69 


12.28 


103.3 


11.75 


11.28 


104.2 


5 to 9 


3.64 


3.32 


109.6 


3.33 


3.03 


109.9 


10to.l4 


2.32 


2.29 


101.3 


2.16 


2.12 


101.9 


15 to 19 


3.76 


3.72 


101.1 


3.58 


3.45 


103.8 


20 to 24 


5.97 


5.42 


110.1 


5.27 


4.96 


106.3 


25 to 34 


9.24 


6.81 


135.7 


6.70 


6.10 


109.8 


35 to 44 


15.90 


10.05 


158.2 


9.23 


8.03 


114.9 


45 to 54 


23.64 


16.03 


147.5 


14.37 


12.58 


114.2 


55 to 64 


40.03 


29.88 


134.0 


28.98 


24.48 


118.4 


65 to 74 


79.68 


59.13 


134.8 


66.91 


51.72 


129.4 


75 and over. . 


145.13 


138.72 


104.6 


129.16 


132.99 


97.1 



The facts for all ages combined in the two mortality experiences, 
on their face, indicate a more favorable mortality among insured 



24 MORTALITY STATISTICS OF INSURED WAGE EARNERS. 

white persons than among the general population. These figures 
are of significance, however, only with respect to the specific sex 
and age classes of the data. We shall see below that this favorable 
condition for all ages results from the peculiar age distribution of 
the group of policyholders. A larger proportion of policyholders 
appears at the ages of low mortality and a smaller proportion at the 
ages of high death rates than occurs in the general population. 
Let us make a comparison first of the figures for males, remember- 
ing throughout this discussion that the data for the insured group 
relate entirely to white lives. 

The first fact of importance in this comparative view of the mor- 
tality of wage earners and of the general population is that for all 
ages under 25 years there is no marked divergence between the rates 
for the two groups under review. There are differences, of course, 
but these are not great. Beginning with the age group 25 to 34 years 
and thereafter there is, however, a marked excess in the rate of mor- 
tality among insured male wage earners over that among males in 
the general population. At these age periods, the special stresses 
of adult life and of employment in arduous labor make themselves 
felt in the mortality experience of males in an industrial life in- 
surance company. Male insured wage earners in the age period 25 
to 34 years, show a mortality rate nearly 36% in excess of the rates 
prevailing among males in the general population. The divergence 
between the two series of mortality figures increases somewhat in 
the next age period, 35 to 44 years, to 58%, and then declines to 48% 
between 45 and 54 years. Thereafter the excess of mortality among 
male insured wage earners is practically stationary at about 35%. 
After age 75, the figures are of no great value. It will be the 
function of the succeeding sections of this report on the several 
causes of death to point out in greater detail the reasons for this 
percentage of excess mortality among insured male wage earners. 

The comparative table for the death rate of insured females in 
the families of wage earners and of females in the general popula- 
tion shows no such striking excesses of mortality as were observed 
in the table for males. Under the age of 35 years there are no 
marked divergences of the mortality curve. After 35 years the ex- 
cess of the mortality rate among insured females becomes significant. 
For the age group 35 to 44 years we observed an excess of 15%, 
which ratio is about the same as that for the succeeding age 
group, 45 to 54 years. For the divisional period 55 to 64 years 



MORTALITY FKOM ALL CAUSES. 25 

we notice an excess of 18% and for the age group 65 to 74 years 
an excess of 39% in the mortality rates of insured females. The 
reader will observe a marked peculiarity in the course of the ratio 
of excess mortality of insured females as compared with that re- 
corded for insured males. In the latter group there was a sharp 
rise in the ratio of excess mortality from age 20 up to and includ- 
ing the age period 35 to 44 years and a decline for the age groups 
thereafter. Among insured females, however, there was no im- 
portant excess in the mortality rates under 35 years of age over 
the rates for females in the general population, but a gradually ris- 
ing rate for each age period thereafter up to and including the last 
significant divisional group, 65 to 74 years. The explanation for 
the difference between one series of ratios and the other will be 
found only upon careful analysis of the facts for the particular 
causes of death in the mortality experience. 

Factors Influencing Industrial Insurance Mortality. 

Before proceeding with any further comparison between the mor- 
tality experience of this group of insured wage earners and the 
mortality experience of the general population, it will be instructive 
to outline briefly some of the important factors which condition 
the mortality experience of an industrial life insurance company, 
and which are not prevalent in the general population. 

The first important source of difference is that these data 
relate entirely to a group of wage earners and their families — 
independent, self-reliant wage earners, to be sure, who have endeav- 
ored to protect themselves as much as possible from the losses inci- 
dent to the last illness and the cost of burial. The great mass of 
the wage earning population in America, however, are not in ordi- 
nary times as well situated to safeguard themselves against the 
effects of accident and disease as are the better situated strata of 
the population. The occupations they engage in are more hazard- 
ous, their families are larger and their incomes smaller than those 
of the general average of the population. These factors determine 
such important health situations as the adequacy of diet, housing, 
clothing, and equally, the standards of medical service at their dis- 
posal. These policyholders, too, live in the larger cities and towns, 
and are subjected to the unfavorable influences of city life. It 
may be expected, therefore, that the mortality experience of this 



26 MORTALITY STATISTICS OF INSURED WAGE EARNERS. 

large group of insured wage earners will show characteristics quite 
different from those of the general population or of special groups 
in the general population which have distinctly better living and 
working conditions. It is perhaps one of the chief functions of 
this report to point out definite lines of further inquiry into the 
general welfare of the wage earning group of the population. The 
more detailed and specialized questions as to the adequacy of wages, 
the level of the standard of living of American workingmen's fami- 
lies, of housing conditions, of hours of labor, of the intensity of 
labor, and of hygienic conditions in workshops and factories should 
be submitted to careful and conclusive inquiry. The supply of 
data on these important vital facts is at present severely limited. 
These mortality statistics provide, we believe, a sound point of 
departure for such qualified inquiry into the facts of the life and 
work of the American wage earner. 

Downwa/rd Trend of Mortality of Insured Wage Earners from 1911 

to 1916. 

The important feature of this mortality experience is the capac- 
ity for decrease shown by the death rate in the brief period covered by 
this study. In the six years 1911 to 1916 inclusive, the death rate 
fell from 13.53 to 11.68 per 1,000 exposed, or a decline of 6.8%. 
Between the five years 1911 to 1915 the tendency was steadily down- 
ward year after year. It was only in 1916 that this tendency was 
cheeked, apparently as the result of a widespread prevalence of 
acute respiratory diseases, chiefly of the influenzal type. But even 
this serious condition had only a minor effect, raising the death 
rate by .4 per 1,000 persons exposed over the figure for 1915. 

The amount of decline is much more marked if we consider 
white lives only. Between 1911 and 1916, the per cent, decline 
among white lives was 7.2. There is also a slight difference in 
the amount of improvement in the two sexes, the per cents, of 
decline among white males and white females being 6.0 and 8.2 re- 
spectively. For colored persons, the decrease was only 1.4%. 
There were fluctuations in the colored rates in an upward and down- 
ward direction during the several years. The colored males show 
an actual increase of 1.4% in mortality while the colored females 
show an improvement of 3.7%. The following table gives the 
death rates for the several groups of insured wage earners for each 
of the years 1911 to 1916 and for the entire six-year period : 



MOKTALITY PROM ALL CAUSES. 



27 



TABLE 11. 

Mortality from All Causes of Death Combined. 

AND BY Sex. 



Classified by Color 



Death Bates Per 1,000 Persons Exposed. Single Years 1911 to 1916. 

Experience of Metropolitan Life Insurance Company, Industrial 

Department. 





Persons. 


WWte. 


Colored. 


Year. 


Males. 


Females. 


Males. 


Females. 


1911 to 1916 


11.81 


11.82 


10.40 


17.63 


16.89 


1916 


11.68 
11.31 
11.53 
11.99 
12.01 
12.53 


11.83 
11.05 
11.48 
12.20 
11.97 
12.58 


10.21 
10.04 
10.18 
10.49 
10.55 
11.11 


17.68 
17.42 
17.38 
17.90 
17.98 
17.42 


16.85 


1915 


17.12 


1914 

1913 


16.51 
16.29 


1912 


17.12 


1911 


17.50 











Reduction of Mortality in the General Population of the Expanding 
Registration Area and among Insured Wage Earners Compared. 

For purposes of comparison, we must again turn to the facts for 
the general population as reflected in the figures of the expanding 
Registration Area. These figures will indicate whether the marked 
improvement which we have observed among insured lives is par- 
alleled by the conditions in the general population or whether the 
insured have enjoyed conditions which were especially favorable to 
them. In view of the fact that the detailed figures for 1916 for the 
Eegistration Area are not as yet available and also because the in- 
surance experience begins with 1911, we shall limit our comparison 
of the two experiences to the five-year period 1911 to 1915 
inclusive. 

For the total Eegistration Area of the United States there was 
observed between 1911 and 1915 a decline of only 4.7 per cent. 
This compares with a 9.7 per cent, decline among the white in- 
sured group in the same five year period. It must be remembered 
also that the insurance figures do not include facts for infants under 
one year of age as do the foregoing data for the Eegistration Area 
of the United States. The improvement in infant mortality dur- 
ing the period under examination has been very marked and this 
undoubtedly has had a very favorable influence on the total death 
rate of the Eegistration Area. If the expanding Eegistration 



28 MORTALITY STATISTICS OF INSURED WAGE EARNERS. 

Area data at all ages were to be arranged for only those lives above 
one year of age, as is the case for the Metropolitan experience, a 
less favorable reduction than 4.7% would undoubtedly be found 
and the advantage in favor of the insured would be even more 
striking. 

In order to compare the facts for each of the two sexes, we may 
safely use the figures for all males in the Eegistration Area and 
contrast them with those for white males in the insurance expe- 
rience, because the composition of the Eegistration Area is sub- 
stantially white. Between 1911 and 1915, males in the Eegistra- 
tion Area showed a reduction of exactly 5% in mortality as com- 
pared with a percentage reduction of 13.3 among the insured 
white males. Females in the general population at all ages show 
a decline of only 4.3%, as compared with a decline of 9.6% among 
insured white females at ages one and over. Taking all white lives 
together, the insured group showed a decline in mortality of eleven 
per cent, and all the white lives in the Eegistration Area a decline 
of only 5.4%. 

The percentage of decline of mortality among colored lives was 
more pronounced for the general population than for insured col- 
ored wage earners, but was small in each instance. The group of 
colored persons in the population of the Eegistration Area showed 
a reduction of 2.7 per cent., whereas, the entire group of colored 
lives in the insurance experience showed a reduction of only 1.3% 
between 1911 and 1915. This improvement was entirely confined 
to the colored females. The percentage of decline of colored mor- 
tality in the general population and among insured wage earners 
does not affect a very large number of lives exposed in either experi- 
ence and may be disregarded for comparative purposes in the 
present discussion. This can readily be done in view of the fact 
that insured colored persons are located almost entirely in urban 
areas, whereas a fair proportion of the negroes in the Eegistration 
Area are rural dwellers. It will be seen, therefore, that the mor- 
tality experience of insured white wage earners shows by far the 
more favorable general tendency when compared with the mortality 
experience of the general population. 

The following table presents a comparison of the death rates of 
the aggregate white and colored groups among the insured and the 
general population for the period 1911 to 1915 as well as the per 
cent, reduction between the two periods. 



MORTALITY FROM ALL CAUSES. 



29 



TABLE 12. 

Mortality from Au:, Causes of Death Combined. 

Death Bates Per 1,000 Persons Exposed, 1911 to 1915. 

White and Colored Lives, Males and Females, of Expanding Registration 

Area of the United States and in Experience of Metropolitan Life 

Insurance Company, Industrial Department, Compared.* 





Wlite Lives. 


Colored Lives. 


Males. 


Females. 


Year. 












M. L. I. 




M. L. I. 




Reg. 


M. L.I. 


Reg. 


M. L.I. 


Reg. 


Co. Wh. 


Keg. 


Co. Wh. 




Area. 


Co. 


Area. 


Co. 


Area. 


Males. 


Area. 


Females. 


1915 


13.00 


10.49 


23.04 


17.26 


14.26 


11.05 


12.69 


10.04 


1914 


13.16 


10.77 


21.96 


16.90 


14.46 


11.48 


12.71 


10.18 


1913 


13.65 


11.26 


21.92 


17.02 


15.00 


12.20 


13.09 


10.49 


1912 


13.47 


11.20 


22.92 


17.51 


14.75 


11.97 


12.94 


10.55 


1911 


13.74 


11.79 


23.69 


17.46 


15.01 


12.58 


13.26 


11.11 


Per cent de- 


^ 
















cline 1911 


[5.39 


11.03 


2.74 


1.15 


5.00 


12.16 


4.30 


9.63 


to 1915.. . 


J 

















* Registration Area rates are for all ages; insurance experience applies 
only to ages one and over. 



A more intimate view of these two experiences will be afforded 
when the data for each of the important diseases and conditions are 
taken up. In these later sections we shall direct attention to the 
conditions which are largely responsible for the progressively favor- 
able mortality of white insured lives as compared with the general 
population of the expanding Registration Area of the United States. 



CHAPTER III. 

Mortality feom Peincipal Causes of Death. 

The main outlines of the mortality experience of insured wage 
earners for all causes of death combined appear in the foregoing 
text. Data of this type, however valuable, are rather bare in their 
public health value unless supplemented by further analysis accord- 
ing to the principal diseases and conditions responsible for the mor- 
tality. It is one of the favorable features of this report that we 
were able to secure exceptionally complete statistics of the causes 
of death in the course of our tabulations. The documents avail- 
able for our study, namely, the so-called " claim papers " contain, 
usually, a number of statements of the disease or condition causing 
death. The most important of these is, of course, the certificate as 
submitted by the attending physician, who, in the great majority of 
the cases, also completes the official death certificate for the use of 
the general registration service of the community in which the in- 
sured person dies. There are also at hand the statements of the 
cause of death as made by the beneficiary, who represents the fam- 
ily of the deceased, as well as that completed by the local represen- 
tatives of the company. Often newspaper clippings and other il- 
luminating additions are attached to the papers, and especially in 
cases of accidental death or where a coroner's inquest is called for. 

Effort to Improve Accuracy of Certified Causes of Death. 

Every effort has been made in the conduct of this mortality study 
to secure from certifying physicians as complete and accurate state- 
ments of the diseases or conditions causing death as practicable. 
This end was achieved by means of an extensive system of corre- 
spondence with the certifying physicians, pointing out where cer- 
tain forms of statements of diseases causing death were unsatis- 
factory for statistical use, and what manner of additional clarify- 
ing information we desired to have. A few examples may be cited 
to illustrate the procedure. 

1. The physician reports on the death certificate that a child has died 
from "bronchopneumonia." In view of the fact that this disease or condi- 

30 



MOKTALITY FROM PRINCIPAL CAUSES OF DEATH. 31 

tion is so often a terminal state of infectious disease, our letter asked the 
physician to say whether any infection, such as measles or whooping cough, 
or whether trauma was the primary causative condition. In numerous in- 
stances, physicians replied to our inquiries and said that they had omitted 
to certify to the primary infection or condition, i. e,, measles, whooping 
cough, scarlet fever, etc. 

2. "Peritonitis" is also a statement of cause of death which does not 
convey to the compiling statistician the information he must have in order 
to report upon the prevalence of the socially important primary diseases and 
conditions which result in fatal "peritonitis." In this instance, the letter 
of inquiry asks the physician whether the "peritonitis" followed a surgical 
operation for any one of many conditions such as appendicitis, ulcer of the 
stomach, cancer of the stomach or of the intestines, etc., or whether, in the 
case of a woman of child-bearing age, the "peritonitis" was the sequel of 
any condition associated with the maternal state. The facts of mode and 
nature of accidental, homicidal or suicidal injury, were also inquired for. 

3. "Injury" is a report which may be properly chargeable to either 
of the primary subdivisions of violence: suicide, homicide or accident. 
These, in turn, are classified accurately only if the means of "injury" is 
given. A death reported in this way, if it was suicidal, may have been 
primarily due to suicide by gunshot wound, or by a cutting instrument, or 
by jumping from a high place; if accidental, the means of "injury" may 
have been a firearm, a cutting instrument, an accidental fall, a fall or an 
explosion in a mine or quarry — death may have been due, indeed, to a 
machinery accident, a railroad accident, a street-car accident, or to any one 
of many accidental causes. Inasmuch as the International List of Causes 
of Death provides for the separate grouping of each of the means of 
"injury" cited above, we can not classify a report like "injury," "frac- 
ture," "wound," "traumatism," or any of many similar reports with 
accuracy unless information is provided as to the means or manner in which 
the "injury," etc., occurred. The letter of inquiry sent to the certifying 
physician in such cases usually results in the receipt of data covering the 
additional circumstances that are required for the final assignment of the 
cause of death. 

These three examples, of many, indicate in general the principle 
underlying this method of clearing up indefinite and otherwise un- 
satisfactory reports of diseases or conditions causing death.* In 
another publication,! there will be found a rather complete discus- 
sion of the methods and results of this inquiry system and the prob- 

* Other indefinite terms subject to inquiry are : ' * Accident, " " operation, ' ' 
*' acute nephritis," "meningitis," "tumor," "septicemia," and many 
others. 

t ' ' Improvement of Statistics of Cause of Death through Supplementary 
Inquiries to Physicians." Quarterly Publications of the American Statis- 
tical Association, June, 1&16. 



32 MOETALITY STATISTICS OF INSURED WAGE EAENEKS. 

able effect of the method in improving the precision of the state- 
ment of the various primary causative factors in mortality. There 
were received from certifying physicians in connection with the 
deaths reported in this six year mortality investigation about 25,000 
letters. In the great majority of cases, the information conveyed 
by these letters made it possible for us to reach a much closer ap- 
proximation to the real facts respecting the several important dis- 
eases and conditions among insured wage earners. An analysis of 
the returns from the inquiry procedure shows that in a period of 
six years the death rate for such an undesirable title as "frac- 
tures" was reduced 65%, for "simple peritonitis" the reduction 
was 41% and for " acute nephritis " 21%. The registration of cer- 
tain more definite causes of death was improved; for example, 
measles and scarlet fever showed an increase of 3% each, cancer 
of the breast 5%, tuberculous meningitis nearly 13%, syphilis 
97%, and gonococcus infection 138%,— all through the direct in- 
fluence of this inquiry method. Appendix C shows the number 
of deaths charged to certain causes before and after inquiry, and 
the percentage of changes in classification. 

Nomenclature and Classification of Diseases. 

If no pains were spared to secure complete original data on the 
diseases and conditions responsible for mortality among insured 
wage earners, every effort was also made to handle the material 
received by the Statistical Bureau in a manner so approved that 
the tabulations would be comparable with those of the best statis- 
tical offices of the country and especially the Federal Bureau of 
the Census. The diseases and conditions causing death reported 
upon the certificates were compiled according to the "Interna- 
national List of Causes of Death." The great variety of terms 
used by physicians in various parts of the country were thus 
brought together and made to agree with the standard nomenclature 
as followed by the Census Bureau. In addition, the rules and regu- 
lations of the "Manual of the International List of Causes of 
Death" were followed in handling "jointly reported causes of 
death." While published statistics of causes of death are neces- 
sarily stated in terms of single diseases or conditions, physicians 
on their certificates often give a number of such causes. The rules 
of the Manual indicate clearly the procedure to follow in such 



MOETALITY FEOM PEINCIPAL CAUSES OF DEATH. 33 

cases and these were strictly adhered to. The list of precedents of 
the Bureau of the Census as published in the "Index of Joint 
Causes — 1914 " served also as our guide in the treatment of " Jointly 
reported causes of death." The results of this mortality experience 
for insured wage earners are, therefore, substantially comparable 
with the facts published for the Eegistration Area. 

To carry on this work, as well as to tabulate the various non-med- 
ical items of our study, it was necessary to organize a specially 
selected and trained staff. Virtually every item appearing in this 
volume was codified by one clerk and checked by another. The 
sorting and tabulation processes were in like manner always certi- 
fied as to their accuracy. The watchword throughout the whole 
study conducted over a period of six years has been " care." These 
precautions have been taken because it was felt from the very be- 
ginning that we should do all in our power to offset the inherent 
deficiencies in the material as returned by physicians ; for, even in 
large cities, where the best conditions of medical practice prevail, 
there is a certain irreducible amount of uncertainty and inaccuracy 
in statements of cause of death. We have felt that these should 
not be augmented through any element of indifference or careless- 
ness in the statistical procedure followed. It is our firm belief that 
we have in this mortality investigation of insured wage earners as 
accurate and authentic a record of the principal diseases and condi- 
tions causing death as it has ever been possible to obtain in any 
similar enterprise anywhere. 

The following table presents a list of the number of deaths and 
of the death rates per one hundred thousand persons exposed for 
each of the titles in the detailed International List of Causes of 
Death. 



3 



P^ 






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42 MOETALITY STATISTICS OF INSUIIED WAGE EARNERS. 

The remainder of this report will be concerned with a detailed 
consideration of the more important diseases and conditions which 
appear in this experience. These will be taken up in the order of 
their numerical importance. At this point we need point out only 
that, as in most other experiences, a few conditions account for the 
larger part of the mortality. Tuberculosis (all forms), for ex- 
ample was responsible for 17.4% of all the deaths. This title was 
followed by "organic diseases of the heart" with 11.9% ; by pneu- 
monia (all forms), with 9.1%; and by Bright's disease with 8.2% 
of all the deaths. The entire group of " external causes," of which 
accidents form the largest part, was responsible for 8.0%. To- 
gether these five principal disease groups accounted for 54.6% of 
the total mortality. In addition, we may mention cancer (all 
forms) with 5.9% of the deaths, cerebral hemorrhage and apoplexy 
with 5.8% and the four communicable diseases of childhood, 
namely, measles, scarlet fever, whooping cough and diphtheria, 
which, together, accounted for 4.0%. These, added to the figure 
already noted, bring the total up to 70.3% of all the deaths. We 
shall now consider each of the conditions in the order named, and 
shall add a number of others which seem to be of suJBScient value 
to merit discussion because of their great interest to medical science 
or because they throw light on the vital phenomena of wage earners 
and their families. 



CHAPTEE IV. 
Tuberculosis. 

Notwithstanding the great development in America of the cam- 
paign against tuberculosis, detailed statistics of mortality from 
this condition are not as yet available for the general population 
in a manner suitable for the purposes either of intensive study or 
of practical health work. The present collection of data of mor- 
tality from tuberculosis among wage earners presenting the facts 
in full for color, sex and age, constitutes therefore an important 
contribution to the literature on the subject. The value of these 
figures is commensurate with the gravity of the condition. For 
not only is tuberculosis the first cause of death as to incidence 
among wage earners and their families, but mortality from this 
cause is most pronounced at a time in life when there is still con- 
siderable expectation remaining to each individual and when death 
seriously disrupts family life. The economic losses thus entailed 
are still further augmented by the long periods of physical disabil- 
ity which usually precede the fatal termination. Tuberculous dis- 
ease is clearly the chief burden upon the vital resources of wage 
earners and their families. The figures we present, it is hoped, 
will become a point of departure for further inquiry into the pos- 
sible effect of environmental and other factors which condition the 
physical welfare of the great mass of the wage earning population. 

Tuberculosis in all its forms accounted for 110,363 deaths or 
17.4% of the 635,449 deaths in the entire Industrial mortality ex- 
perience for the six year period, 1911 to 1916. The deaths cover 
a number of conditions which are clearly distinguishable according 
to the main organs or parts of the body affected by the tuberculous 
infection. The following table shows the number of deaths re- 
sulting from each of the several forms of tuberculosis as distin- 
guished in the nomenclature of the International List : 



43 



44 



MORTALITY STATISTICS OF INSURED WAGE EARNERS. 



TABLE 14. 
MOETALITT FROM TUBERCULOSIS, SPECIFIED ACCORDING TO ORGANS OR PaBTS 

Affected. Deaths, and Death Eates Per 100,000 Persons Exposed. 
All Color and Sex Groups Combined. 
Experience of Metropolitan Life Insurance Company. Industrial Depart- 
ment. 1911 to 1916. 





All Color and Sex Groups In Mortality Experience. 


Organ or Part Affected. 


No. of 
Deaths. 


Percentage 

of Total, 

All Causes. 


Percentage 
of Total 
Tubercu- 
losis. 


Rate per 
100,000 
Exposed. 


Tuberculosis — all forms 


110,363 


17.4 


100.0 


205.1 


Tuberculosis of the lungs . . . 
Acute miliary tuberculosis . . 

Tuberculous meningitis 

Abdominal tuberculosis 

Pott's disease 


93,526 

6,380 

4,647 

3,155 

866 

573 

959 

257 


14.7 
1.0 
.7 
.5 
.1 
.1 
.2 
t 


84.7 

5.8 

4.2 

2.9 

.8 

.5 

.9 

.2 


173.9 

11.9 

8.6 

5.9 

1.6 


White swellings 

Tuberculosis of other organs 
Disseminated tuberculosis . . 


1.1 

1.8 

.5 



t Less than .05 per cent. 



Considered according to organs or parts affected, tuberculosis of 
the lungs was the chief form of the disease, accounting for 84.7% 
of all the deaths from tuberculosis. The rate of mortality was 173.9 
per one hundred thousand exposed. In the discussion of tubercu- 
losis of the lungs to follow, we shall accept the practice of the 
Abridged International List of Causes of Death and shall include 
with this form of tuberculosis, the deaths from acute miliary tuber- 
culosis, of which there were 6,380 recorded during the six year 
period of this investigation. Considering these two forms together 
as tuberculosis of the lungs, this disease was responsible for 15.7 
per cent, of the deaths from all causes and 90.5 per cent, of the 
deaths from all forms of tuberculosis. A rate of 185.7 per one 
hundred thousand exposed is registered. The only other forms of 
tuberculosis of numerical importance in this mortality experience 
were tuberculous meningitis and abdominal tuberculosis, which 
assume considerable importance at certain periods of life. 

The above picture is a composite covering both races and sexes 
and all age periods of life. Our very first analysis, however, indi- 
cates that this composite reduces itself into a number of varying 
elements. Thus, we find that the colored have a much higher in- 
cidence than the white policyholders, that the rates for the males 



TUBERCULOSIS. 



46 



exceed those for females, and finally, that the figures for each 
main color and sex class vary markedly with age. The first five 
year period of life presents a comparatively high rate. This drops 
to the minimum between 5 and 9 years. With the next period, 10 to 
14 years, the figures mount again and increase continuously to 
their maximum which is attained between 35 and 44 years, among 
males and somewhat earlier among females. The rates then de- 
cline rapidly with advancing age. These facts are presented in 
the following table: 

TABLE 15. 

Mortality from Tuberculosis, All Forms, Classified by Color, Sex 

AND BY Age Period. 

BeatTi Bates per 100,000 Persons Exposed. 1911 to 1916. 

Experience of Metropolitan Life Insurance Company. Industrial 
Department. 





Persons. 


WWte. 


Colored. 


Age Period. 


Males. Females. 


Males. 1 Females. 


All ages — one and 
over 


205.1 


211.9 


147.3 


430.0 


385.1 


1 to 4 

5 to 9 

10 to 14 

15 to 19 .. 

20 to 24 

25 to 34 

35 to 44 

45 to 54 

55 to 64 

65 to 74 

75 and over . . . 


90.7 
37.6 
46.4 
165.0 
287.8 
344.4 
360.4 
279.6 
237.2 
196.0 
177.7 


78.4 

26.3 

19.0 

98.5 

243.8 

385.8 

540.4 

463.5 

365.5 

268.2 

197.2 


76.5 
29.3 
38.5 
144.5 
238.0 
252.2 
215.2 
147.8 
139.1 
140.3 
151.5 


269.2 
135.2 
145.8 
420.7 
584.4 
568.9 
570.1 
465.1 
438.8 
342.4 
315.5 


268.4 
152.5 
277.5 
621.3 
643.9 
488.6 
349.9 
243.9 
198,9 
175.0 
245.0 



This marked variation with age and especially the presence of 
two modal points of incidence, namely in infancy and in adult life, 
suggest that we are concerned with heterogeneous material. In fact 
we know that the variations result in large part from the inclu- 
sion in our figures of the several forms of tuberculosis which 
affect the age periods very differently. It will be more instructive, 
therefore, in our further analysis to consider each of the chief forms 
of tuberculosis separately. We shall discuss first the data for 
tuberculosis of the lungs, follow with tuberculous meningitis and 
abdominal tuberculosis and close with a brief reference to the few 
remaining titles included in our main group. 



46 



MORTALITY STATISTICS OF INSURED WAGE EARNERS. 



Tuberculosis of the Lungs. 

It will be understood that this title includes the deaths under 
the title as such and also the group of deaths assigned to acute 
miliary tuberculosis, i. e., titles Nos. 38 and 29 of the Interna- 
tional List together. 

A total of 99,906 deaths is reported under this head correspond- 
ing to a death rate of 185.7 per 100,000 in the six years, 1911 to 
1916. In view of the fact that 90.5% of the total tuberculosis 
deaths are thus covered, we may expect that many of the color, sex 
and age characteristics observed for all forms of tuberculosis will 
again be in evidence — ^but we shall note also some variations. The 
following table presents the death rates per 100,000 exposed for 
tuberculosis of the lungs, grouped according to the color, sex and 
age classes represented in our data : 

TABLE 16. 

Mortality feom Tuberculosis op the Lungs,* Classified by C!olob, Sex 

AND BY Age Period. 

Death Bates per 100,000 Persons Exposed. 1911 to 1916. 

Experience of Metropolitan Life Insurance Company. Industrial 
Depari;ment. 





Persona. 


White. 


Colored. 


Age Period. 


Males. Females. 


Males. 


Females. 


All ages — one and 
over 


185.7 


193.7 


131.5 


391.2 


348.5 






1 to 4 

5 to 9 

10 to 14 

15 to 19 

20 to 24 

25 to 34 

35 to 44 

45 to 54 

55 to 64 

65 to 74 

75 and over . . . 


26.3 
16.2 
33.9 
150.5 
273.4 
330.1 
345.4 
267.3 
221.1 
178.7 
156.1 


17.0 
7.7 
9.8 

87.7 
232.9 
373.3 
527.1 
450.6 
345.0 
250.0 
180.2 


18.2 
11.1 
28.5 
133.7 
226.2 
241.2 
203.5 
137.8 
128.5 
126.2 
127.2 


135.2 

79.3 

110.4 

377.8 
547.6 
541.2 
542.7 
444.0 
408.2 
309.0 
301.8 


152.3 
99.1 
232.4 
572.7 
608.0 
461.8 
322.3 
226.1 
175.2 
146.8 
217.8 



* Includes "tuberculosis of the lungs," title 28, and "acute miliary 
tuberculosis, ' ' title 29 of the International List. 



It will be seen that the group of colored persons in this ex- 
perience shows a pulmonary tuberculosis death rate at all ages, one 
and over, between two and two and one-half times that of white 



TUBERCULOSIS. 



47 



persons. Colored males, for instance have a tuberculosis death 
rate at all ages which is 203.0 per cent, that of white males; col- 
ored females show a tuberculosis death rate 265.0 per cent, that of 
the white female rate. These figures vary markedly when consid- 
ered by age; in fact, the most instructive relations between the 
two races are thus brought to light. One interesting feature is the 
comparatively early age at which the maximum death rate is found 
among the negroes, namely, between 20 and 24 years. Among 
white males, ^he maximum is reached between 35 and 44 years, and 
among white females, between 25 and 34 years. As will be ob- 
served in the table above, the mortality from tuberculosis of the 
lungs among colored males at the age period 5 to 9 years is over 
ten times as great as among white males at that age. Between 
the ages 10 and 14 years, the colored male rate for tuberculosis of 
the lungs is over eleven times that for white males. Among colored 
females under 15 years of age, the excess of mortality for tubercu- 
losis of the lungs over the figures for white females is also very 
great, being over eight times as high in each five-year period. It is 
of more than ordinary interest to indicate that between the ages 45 



TABLE 17. 

MORTAIilTY FBOM TUBEECULOSIS OP THE LUNGS.* 

Percentage, Colored of White Death Bates for Each Sex, Classified by Age 
- Period. 1911 to 1916. 

Experience of Metropolitan Life Insurance Company. Industrial 
Department. 





Percentage, Colored of White Mortality. 


Age Period. 


Male. 


Female. 


All ages — one and over 


202.0 


265.0 


1 to 4 


795.3 

1029.9 

1126.5 

430.8 

235.1 

145.0 

103.0 

98.5 

118.3 

123.6 

167.5 


836 8 


5 to 9 


892 8 


10 to 14 


815 4 


15 to 19 


428 3 


20 to 24 


268 8 


25 to 34 


191 5 


35 to 44 


158 4 


45 to 54 


164 1 


55 to 64 


136.3 


65 to 74 


116 3 


75 and over 


171 2 







* Includes "tuberculosis of the lungs," title 28, and 
tuberculosis, ' ' title 29 of the International List. 



' acute miliary 



48 



MOETALITY STATISTICS OF INSURED WAGE EAENERS. 



and 54 the death rate from tuberculosis of the lungs among colored 
males was slightly less than that recorded for white males. The 
maximum percentage of excess of colored mortality from tubercu- 
losis of the lungs over the figures for white persons occurred in the 
age period 10 to 14 years for males and 5 to 9 years for females. 
There is at present no explanation at hand as to why this ex- 
cess of colored over white mortality from tuberculosis of the lungs 
should be so great at the periods of early life and so much smaller 
in later years. 

The preceding table presents a picture of the relative incidence 
of pulmonary tuberculosis among white and colored persons. 

Tlie Death Rate of Pulmonary Tuberculosis according to Sex. 

The second main classification of these data will be made ac- 
cording to sex. As is to be noted in Table 16, the differences in the 
rates of the two sexes were very marked indeed, the degree of differ- 
ence varying somewhat for each of the two races. The following 
table exhibits the ratio of the male to the female death rate at 
each age period for the two color classes of this experience : 



TABLE 18. 
MOETALITY FROM TUBERCULOSIS OF THE LUNGS.* 

Percentage, Male of Female Death Bates for Each Color or Bace Group, 
Classified hy Age Period. 

Experience of Metropolitan Life Insurance Company. Industrial Depart- 
ment. 1911 to 1916. 





Percentage, Male of Female Mortality. 


Age Period. 


White. 


Colored. 


All ages — one and over 


147.3 


112.3 


1 to 4 


93.4 

69.4 

34.4 

65.6 

103.0 

154.8 

259.0 

327.0 

268.5 

198.1 

141.7 


88.8 


5 to 9 


80.0 


10 to 14 


47.5 


15 to 19 


66.0 


20 to 24 


90.1 


25 to 34 


117.2 


35 to 44 


168.4 


45 to 54 


196.4 


55 to 64 


233.0 


65 to 74 


210.5 


75 and over 


138.6 



* Includes "tuberculosis of the lungs," title 28, and "acute miliary 
tuberculosis," title 29 of the International List. 



TUBERCULOSIS. 49 

Considering all ages one and over together, the ratio of white 
male to white female mortality is 147.3, which means an excess of 
nearly one half. The excess in the rate of colored males over col- 
ored females is only 12.3%. In both races, however, the picture 
is a shifting one when we introduce the factor of age period. Thus 
under age 20 for the whites and under age 25 for the colored, the 
male rate for pulmonary tuberculosis is considerably lower than 
that for females. In fact between the ages 10 and 14 years the 
rate for white males is over 65% more favorable than that for white 
females. Beginning with the age period 20 to 24 years, however, 
mortality from tuberculosis of the lungs among white males is, at 
every age period, in excess of the figures for white females. The 
maximum percentage of difference is found in the age period 45 to 
54 years where the white male rate is over 3| times that for the 
white females. For the group of colored persons, beginning with 
the age period 25 to 34 years, the death rates from tuberculosis of 
the lungs for males exceed those for females in marked degree. 
The percentage of male excess under the age of 65 is not as great 
for colored lives as for white lives. 

The figures themselves suggest no clue toward an explanation of 
the remarkable differences prevailing in the rates for pulmonary 
tuberculosis among boys and girls of both races. At these younger 
ages, conditions of life are very much the same, and it is difficult 
to understand what factors can be at work unless they be the differ- 
ing inherent physical characteristics of the two sexes. 

The following graph shows clearly the incidence of pulmonary 
tuberculosis in each of the age periods of our main groups, namely, 
white males, white females, colored males and colored females. It 
will be observed that the curves in each instance show a local maxi- 
mum or modal point at the earliest age period, namely, one to four. 
The lowest point is attained in the next age period. Thereafter, 
a distinctly different contour is observed in each of the four curves. 
That for white males is the most symmetrical of all, showing one 
modal point between 35 and 44 years of age. Colored males, on 
the other hand, present an asymmetrical distribution with two 
modal points, one at 20 to 24 years and the other at 35 to 44 years. 
A further irregularity is observed at the period 55 to 64 years. 
The curves for the females are both skew, and are also characterized 
by the early age at which the maximum incidence is attained. Of 
5 



50 



MORTALITY STATISTICS OF INSURED WAGE EARNERS. 



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TUBERCULOSIS. 



51 



the two, the colored females show a much more symmetrical distri- 
bution of the rates by age. 

These graphs recall those which Dr. Brownlee has presented for 
certain geographical areas and occupation groups in his analysis 
of the incidence of pulmonary tuberculosis in Great Britain.* Our 
curve for white males corresponds very closely with that for males 
of London, where the middle age type of pulmonary tuberculosis 
prevails. The colored males, on the other hand, present a picture 
not very different from that described by Brownlee for Ireland, 
where the young adult type of pulmonary tuberculosis prevails. 
This is even more marked among the colored females, where the 
young adult type prevails with very little admixture of the middle 
age type. The curve for the white females recalls nothing m 
the presentation by Dr. Brownlee but seems to be an admixture 
of all three types. We are not inclined, however, to consider these 
graphs a verification of the hypothesis of Brownlee, which was that 
there are three types of tuberculosis; one causes death among the 
young, the second affects middle ages chiefly, the third type affects 
persons in old age. Our purpose is only to show that the same 
conditions which that writer found in Great Britain are repeated 
here, whatever may be the ultimate explanation for the irregular 
distributions which are found to characterize the death rates from 
pulmonary tuberculosis in the several color and sex classes. 

Comparison of Rates with Those of the Expanding Registration 

Area. 

We wish now to present some comparative data for the incidence 
of tuberculosis of the lungs among the group of insured white wage 
earners and the entire population of the expanding Eegistration 
Area of the United States. In the first instance our data relate to 
observations in the period 1911 to 1916 and in the second or popu- 
lation group, the period of observation is 1910 to 1915. This 
minor difference in the years covered by the two studies does not 
materially affect the comparison. The following table gives the 
death rates per 100,000 : 

* * ' Certain Considerations Eegarding the Epidemiology of Phthisis Pul- 
monalis," Public Health, March, 1916, London. 



52 



MOKTALITY STATISTICS OF INSURED WAGE EAENEES. 



TABLE 19. 
MOETALITT FEOM TUBERCULOSIS OF THE LUNGS.* 

Death Bates Per 100,000 Persons Exposed. Classified by Sex and hy Age 
Period. Insured White Lives in Experience of Metropolitan Life In- 
surance Company, Industrial Department (1911 to 1916) and Gen- 
eral Population of Expanding Registration Area of the United 
States (1910 to 1915). 





Males. 


Females. 


Age Period. 


M. L. I. Co. 

(White). 


U. S. Keg. 
Area. 


Per Cent. 
M. L.I. Co. 
of Reg. Area. 


M. L. I. Co. 
(White) . 


U. S. Reg. 
Area. 


Per Cent. 
M. L. I. Co. 
of Reg. Area. 


All ages — one 
and over . . 


193.7 


147.9 


131.0 


131.5 


116.7 


112.7 


1 to 4 


17.0 


24.3 


70.0 


18.2 


23.6 


77.1 


5 to 9 


7.7 


9.8 


78.6 


11.1 


12.7 


87.4 


10 to 14 


9.8 


13.3 


73.7 


28.5 


31.6 


90.2 


15 to 19 


87.7 


81.6 


107.5 


133.7 


116.5 


114.8 


20 to 24 


232.9 


167.6 


139.0 


226.2 


181.2 


124.8 


25 to 34 


373.3 


207.4 


180.0 


241.2 


189.7 


127.1 


35 to 44 


527.1 


237.9 


221.6 


203.5 


153.8 


132.3 


45 to 54 


450.6 


232.2 


194.1 


137.8 


117.2 


117.6 


55 to 64 


345.0 


231.5 


149.0 


128.5 


122.3 


105.1 


65 to 74 


250.0 


205.5 


121.7 


126.2 


147.1 


85.8 


75 and over. . 


180.2 


160.0 


112.6 


127.2 


140.7 


90.4 



* Includes ' ' tuberculosis of the lungs, ' ' title 28, and ' ' acute miliary 
tuberculosis," title 29 of the International List. 



The foregoing (iata indicate that among insured white males, all 
ages one and over, the mortality from tuberculosis of the lungs 
was 31% higher than among all males of the general popula- 
tion (excluding under one year of age). Females in the families 
of wage earners showed an excess of only 13%. It is of the 
greatest interest, however, to discover that in the ages of child- 
hood, that is, under 15, for each sex, the death rate for this con- 
dition was lower among those in the insured white group than 
among those in the general population. The advantage in favor 
of the male children of wage earners was even greater than 
that discovered for female children. Thus between the ages 10 
and 14 years, the mortality rate from tuberculosis of the lungs 
among males in the insured white group was 26.3% less than in 
the general population. The advantage in favor of insured female 
children for the same age period was only 9.8% when compared 
with the rate for female children in the general population. It is 
difficult to say to what this favorable showing for pulmonary 



TUBEECULOSIS. 53 

tuberculosis among the insured may be due, but two factors un- 
doubtedly play an important part. The first is the fact that we 
are comparing white insured children with a mixture of white and 
colored children in the Registration Area. Although the propor- 
tion of colored in this population group is small, the effect of their 
inclusion on the tuberculosis rate may be considerable because of 
the extraordinarily high rates for this condition which prevail 
among colored children. Unfortunately, it is impossible to elim- 
inate the small proportion of the colored from the data of the Reg- 
istration Area. The second factor is one of medical selection which 
results in eliminating a certain number of children of obviously 
poor physique from the insurance experience. Such children 
would later appear in the mortality experience of the Registration 
Area but would not affect the records of the insurance company. 
It is not possible to estimate at the present time the exact weight 
of these two factors. But in any case it is a matter of great 
interest that the children of wage earners, who reside in cities 
and are undoubtedly more exposed to infection and to the hard- 
ships incident to their economic stratum, should show no higher 
rates from pulmonary tuberculosis than children in the general 
population, of whom about one-half reside in rural areas where the 
rate from pulmonary tuberculosis is usually lower than in cities. 

Beginning with the age period 15 to 19 years and continuing up 
to age 64 years for females and up to and beyond age 75 for males,- 
the mortality rates for tuberculosis of the lungs among insured 
white persons were greater than the death rates for this disease 
in the general population of the Registration Area. Thus from 15 
to 19 years the rate for tuberculosis of the lungs among male wage 
earners was 7.5% and the rate among females in wage earning fam- 
ilies was 14.8% in excess of the corresponding rates recorded at 
the same period in the general population. Between 20 and 24 
years of age, male wage earners show an excess of 39%; between 
25 and 34 years an excess of 80% ; between 35 and 44 years an 
excess of 121.6%. Among females the excess of mortality from 
tuberculosis of the lungs among wage earners increases gradually 
up to the period 35 to 44 years. Thereafter the percentage of 
excess mortality decreases until age 65. In the two highest age 
periods, the insured white females show lower death rates than 
females of the general population. 

The following table presents an interesting set of ratios showing 



54 



MORTALITY STATISTICS OP INSURED WAGE EARNERS. 



the relative sex distribution of mortality from pulmonary tuber- 
culosis, by age, among Industrial policyholders and the population 
of the Eegistration Area. 

TABLE 20. 

Mortality prom Tubee,cuix)sis op the Lungs.* 

Percentage, Male of Female Death Bates Per 100,000 Persons Exposed. 

Classified hy Age Period. White Lives, Experience of Metropolitan 

Life Insurance Company, Industrial Department, 1911 to 1916 

and General Population of Expanding Registration Area of 

the United States, 1910 to 1915. 





Percentage, Male of Female Rate. 


Age Period. 


M. L. I. Co. "WMte Lives, 
1911 to 1916. 


Ksp. Reg. Area, U. S. 
1910 to 1915. 


All ages — one and over 


147.3 


126.7 


1 to 4 


93.4 

69.4 

34.4 

65.6 

103.0 

154.8 

259.0 

327.0 

268.5 

198.1 

141.7 


103 


5 to 9 


77 2 


10 to 14 


42.1 


15 to 19 


70.0 


20 to 24 


92.5 


25 to 34 


109.3 


35 to 44 


154.7 


45 to 54 


198.1 


55 to 64 


189,3 


65 to 74 


139.7 


75 and over 


113.7 



* Includes "tuberculosis of the lungs," title 28, and 
tuberculosis," title 2& of the International List. 



' acute miliary 



This table shows that for the ages between 5 and 20 years males 
show a more favorable mortality from tuberculosis of the lungs 
than do females at the same age periods. The difference in favor 
of insured males was even greater than for males in the general 
population. Thus between 5 and 9 years, male mortality from 
tuberculosis of the lungs in wage earning families was 69.4% of 
the mortality among females; the corresponding ratio for the gen- 
eral population was only 77.2%. For the next higher age period, 
10 to 14 years, the advantage in favor of males is even greater than 
before. For the insured experience, males had a rate only 34.4% 
of the female rate, while for the general population the male rate 
was 42.1% of the female rate. Between 15 and 19 years the ratio 
for wage earning families was 65.6% and for the general popula- 
tion 70.0%. It would be interesting if we knew first, why males 
under 20 years of aige show nearly uniformly a lower mortality from 



TUBEECULOSIS. 



65 



tuberculosis of the lungs than do females, and second, why this ad- 
vantage should be more pronounced among male wage earners than 
among males in the families of the general population of the 
United States. Beginning with the age period 30 to 24 years, 
however, the excess of male over female mortality for tuberculosis 
of the lungs was greater in wage earning families than in the gen- 
eral popula-tion of the expanding Registration Area of the United 
States. The foregoing ratios suggest a number of interesting in- 
quiries for future investigation. 

The Downward Trend of Mortality from Tuberculosis of the Lungs. 

In the introductory section of this report, it was pointed out that 
the mortality experience of the insured wage earners had declined 
very appreciably during the six year period covered by this study. 
This decline has been effected primarily through the reduction in 
the incidence of a number of the more important causes of death. 
Pulmonary tuberculosis is one of these. In fact, the decline in the 
death rate from this condition has been more marked in this in- 
surance experience than that from any other single condition of nu- 
merical importance. The following table is presented to show the 
trend of mortality for each of the years since 1911. It will be ob- 
served that the decline has continued generally throughout the en- 
tire period. 

TABLE 21. 

MOETALITT FROM TUBERCULOSIS OF THE LUNGS,* CLASSIFIED BY COLOR AND 

BY Sex. 

Death Bates Per 100,000 Persons Exposed. Single Years in Period 

1911 to 1916. 

Experience of Metropolitan Life Insurance Company. Industrial 

Department. 





Persons. 


White. 


Colored. 


Year. 


Males. 


Females. 


Males. 


Females. 


1911 to 1916 


185.7 


193.7 


131.5 


391.2 


348.5 


1916 


172.8 
180.0 
185.3 
186.6 
191.6 
203.0 


178.1 
184.0 
197.4 
200.0 
198.2 
210.4 


122.8 
127.3 
127.5 
130.7 
137.3 
148.4 


386.8 
399.9 
396.8 
387.0 
397.3 
378.7 


336.8 


1915 


357.0 


1914 


347.8 


1913 


328.9 


1912 


348.0 


1911 


375.1 



* Includes ' ' tuberculosis of the lungs, ' ' title 28, and ' ' acute miliary 
tuberculosis," title 29 of the International List. 



66 



MORTALITY STATISTICS OF INSURED WAGE EARNERS. 



Chart V. — Mortality from Tuberculosis of the Lungs 

Death Kates perlOO.OOOPersons Exposed By Single Years 1911 to 1916 
Experience of Metropolitan Life Insurance Company, Industrial Department 
Death Rate 
per 100,000 

400 



300 



ZOO 



JtOO 




J^j'/s Fe/nsIeJ •_•- 
CoJoreef Females —.. 



J91I 



ipie 



JfiiJf 



J914 



igis 



1916 



TUBERCULOSIS. 67 

The decline in the death rate from pulmonary tuberculosis shown 
in the above table, especially for white lives, is more pronounced 
than that to be noted for the general population in the Registration 
Area. In fact, the acceleration in the decline of the tuberculosis 
rate among wage earners is tending rapidly to close the gap which 
still exists between the death rates for pulmonary tuberculosis 
among wage earners and in the general population. This is indi- 
cated by the fact that in 1911 the excess of the Metropolitan rate 
for white lives over that for the white mortality experience in the 
Registration Area was 40.1%, whereas in 1916 this excess was re- 
duced to 33.8%. Chart V, on page 56, gives a graphic view of 
these facts. 

More instructive figures indicating the nature of the decline in 
the death rate for pulmonary tuberculosis are those which show 
the conditions for each race and sex at each age period of life. 
For by this means, we can localize the groups of the insured where 
the greatest improvement has occurred, where the improvement is 
not so great, and where no improvement has occurred at all. For 
the purpose of this comparison we shall take as our starting point 
the experience of the two years 1911 and 1912 combined and con- 
trast them with the corresponding facts for the two years 1915 and 
191^. The variations which sometimes characterize the experience 
of a single year are in this way reduced. The table on page 58 pre- 
sents the ratios between the experience of 1915 and 1916 combined 
and that for 1911 and 1912 combined, for each one of the groups 
which compose this experience. 

The total experience shows a reduction of 10.6% which is a re- 
markable decrease for a short period of years. The most pro- 
nounced reduction appears for the group of white females although 
the improvement among white males is only slightly less, the per- 
centages of decline being 12.4 and 11.3 respectively. In the Reg- 
istration Area between 1911 and 1915 the per cent, decline for 
males was 5.4 and for females 10.2. Among the colored in the in- 
sured experience the picture is not so encouraging; for among the 
males a slight increase in the rate is found and among the females 
a decrease of but 4%. 

It is difficult to observe any definite law in the amount of re- 
duction in the pulmonary tuberculosis rate in relation to age groups, 
the figures varying so with age period. Among white lives there is 
considerable improvement in the period of childhood after age five 



58 



MORTALITY STATISTICS OF INSURED WAGE EARNERS. 



TABLE 22. 

Mortality from Tuberculosis of the Lungs.* 

Percentage, Death Bate Per 100,000 Exposed in 1915-1916 of Death Bate in 

1911-1912 Classified by Color, Sex and by Age Period. 

Experience of Metropolitan Life Insurance Company. Industrial 
Department. 



1 


Percentage. 1915-1916 Rate of 1911-1912 Rate In Specified Age Period. 


Age Period. 


Persons. 


Wiite. 


Colored. 




Males. 


Females. 


Males. 


Females. 


All ages — one and 
over 


89.4 


88.7 


87.6 


101.3 


96.0 


lto4 

5 to 9 

10 to 14 

15 to 19 

20 to 24 

25 to 34 

35 to 44 

45 to 54 

55 to 64 

65 to 74 

75 and over . . . 


88.0 
85.5 
93.4 
91.2 
84.3 
85.1 
88.5 
95.6 
97.6 
92.5 
94.5 


101.8 

88.6 
90.5 
78.3 
79.8 
82.5 
89.7 

101.1 
99.0 
98.1 

115.4 


98.9 
94.6 
92.7 
96.6 
87.5 
82.0 
83.2 
89.5 
94.7 
84.2 
73.6 


86.0 

92.7 
103.8 
101.2 

91.6 
101.8 
103.7 

88.9 
106.6 

93.9 
216.5 


88.2 

92.4 

104.4 

102.9 

92.7 

96.5 

87.9 

109.0 

103.5 

112.9 

91.2 



* Includes "tuberculosis of the lungs," title 28, and "acute miliary 
tuberculosis," title 29 of the International List. 



and in early adult life. That is true for both sexes. Beginning 
with age 15 the improvement becomes more marked among white 
males. In fact, the greatest reduction of any is to be noted between 
the ages 15 and 24 years. Between 25 and 44 years favorable 
conditions are also noted for both white males and females. There- 
after, the picture is very confusing with a general indication of a 
stationary death rate for the years covered by the study. 

Among the colored, we find a substantial saving in mortality 
under age 10. Between 10 and 19 years the rates show slight in- 
creases. Between 20 and 25 years there is again a noticeable de- 
crease but thereafter the prevailing condition is one of increase 
more or less variable according to age. On the whole, the figuies 
among colored females are more encouraging than those recorded 
for colored males. But even for this sex certain age periods, such 
as 10 to 14 years and 45 to 54 years, show substantial increases. 
The present condition of the evidence does not allow safe prejudg- 
ment of the tendency of the death rate among the colored. Per- 



TUBEECULOSIS. 59 

haps with the accumulation of data in future years a more definite 
tendency may be established. 

There is distinct cause for encouragement in the main findings 
of our inquiry into these facts of tuberculosis mortality according 
to age period. If the rate of 1911 had continued into 1916, the 
number of deaths from pulmonary tuberculosis among policy- 
holders of this Company would have been 20,659 instead of the 17,590 
which actually occurred, a saving of 3,069 lives. We have seen, 
moreover, that the greatest relative decline in the tuberculosis 
death rate has occurred at those age periods where the rates are 
highest and when life is most valuable to the community. 

The favorable aspect of this tuberculosis experience in adult life 
may be the cumulative effect of all phases of public health and spe- 
cialized anti-tuberculosis work of the past twenty years. It is per- 
haps true that the greatest results have been obtained through pre- 
ventive work in behalf of children. Certainly these various efforts 
have tended to increase the vital resistance of children and have 
also changed favorably the circumstances which control the infec- 
tion of young people. 

Tuberculous Meningitis. 

This form of the disease is second only in importance to pul- 
monary tuberculosis. Indeed, in the ages of childhood under age 
10, tuberculous meningitis is the chief form of tuberculosis. In- 
cluded in this tabulation of deaths are fatal cases of tuberculosis 
of the brain and of the cerebrospinal meninges. In all, 4,647 such 
deaths were reported in the six year period between 1911 and 
1916c Of these deaths, 2,324 or fifty per cent, occurred in the age 
period one to four years. A little more than one-fifth of the 
cases were between five and nine years of age. Beginning with 
age ten, the number of deaths is small, although not unworthy of 
consideration. The table on page 60 shows the experience for tuber- 
culous meningitis according to color, sex and age class. 

It should be recalled again that the first age period, one to four, 
does not include infants under one, in which age the highest death 
rates from tuberculous meningitis occur. Thus, in the population 
generally, between one-fourth and one-fifth of all the deaths from 
this disease occur in the first year of life. On the other hand, the 
death rate in the second year of life when the insurance experience 



60 



MORTALITY STATISTICS OF INSURED WAGE EARNERS. 



begins is not much lower than in the first. Such comparisons as 
we shall make with the population figures will, of course, be lim- 
ited to the comparable age period over one and under five years. 

TABLE 23. 
Mortality from Tuberculous Meningitis, Classified by Color, Sex and 

BY Age Period. 

Death Bates Per 100,000 Persons Exposed. 1911 to 1916. 

Experience of Metropolitan Life Insurance Company. Industrial 

Department. 





Persona. 


White. 


Colored. 




Males. 


Females. 


Males. 


Females. 


All ages — one and 
over 


8.6 • 


9.1 


7.7 


11.7 


9.7 




lto4 

5 to 9 

10 to 14 

15 to 19 

20 to 24 

25 to 34 

35 to 44 

45 to 54 

55 to 64 

65 to 74 

75 and over . . . 


51.5 
13.8 
5.4 
4.3 
3.4 
2.6 
2.5 
1.5 
1.6 
1.3 
1.4 


48.8 
12.5 
4.5 
3.6 
2.7 
3.0 
3.0 
1.9 
2.1 
.9 
1.4 


49.1 
13.0 
4.9 
4.4 
3.4 
2.0 
1.7 
1.1 
1.0 
1.5 
1.7 


87.8 
26.3 
10.1 
9.9 
7.2 
3.9 
4.2 
1.6 
1.8 
1.7 


83.8 
25.3 
14.6 
4.7 
4.0 
3.1 
3.4 
2.9 
3.1 
1.2 



During the six year period, deaths from tuberculous meningitis 
were recorded at a rate of 8.6 per one hundred thousand persons ex- 
posed. This crude rate is very low when compared with the rate 
for pulmonary tuberculosis, because the deaths are concentrated 
at the early ages and the exposure includes all ages. Our analysis 
will be significant, therefore, only as we limit ourselves to very 
definite age periods, in fact, to those under fifteen; thereafter, 
tuberculous meningitis is of no very great account as a cause of 
death. The death rate is highest for colored males and least for 
white females. There is no very marked difference between the 
two sexes of each color, although males have a somewhat higher 
rate than females, especially between twenty-five and sixty-five 
years among the whites, and fifteen and forty-five years among the 
colored. The death rates, beginning with the maximum point 
under five years of age, decrease regularly with age up to and in- 
cluding ages forty-five to fifty-four years. There is a somewhat 
fluctuating experience thereafter. Practically the same form of 



TUBEECULOSIS. 



61 



curve is observed for each of the color and sex classes in this ex- 
perience. 

A comparison of the death rates for this condition with those 
prevailing in the Eegistration Area should be limited to the ages 
under fifteen, where the death rates for tuberculous meningitis are 
really significant. Under age ten, the children of white wage 
earners show a somewhat higher mortality rate than do children at 
the same ages in the population of the expanding Eegistration 
Area of the United States. This is true for each sex. Some 
part of the excess may be due to better registration of the disease 
among insured children than in the general population. Our sys- 
tem of inquiry into causes of death results in adding materially 
to the total number of deaths from tuberculous meningitis, for 
such reports as " meningitis " are always returned to physicians for 
additional information. It should be recalled that a net increase 
of fourteen per cent, in the number of deaths recorded for " tuber- 
culous meningitis" was produced by this system of inquiry over 
the number which would have been recorded had the method of 
querying physicians not been adopted. The age period ten to four- 
teen years shows almost identical rates in the population and among 
the insured. The following table presents a comparison of the 
death rates for a few significant age periods for insured lives as 
well as those of the general population of the expanding Eegis- 
tration Area: 

TABLE 24. 
MORTALITT FEOM TUBERCULOUS MENINGITIS. 

Death Hates Per 100,000 Persons Exposed. Classified ty Sex and by Age 

Period. 
Insured White Lives in Experience of Metropolitan Life Insurance Com- 
pany, Industrial Department (1911 to 1916) and General Population of 
Expanding Eegistration Area of the United States (191 (> to 1915). 





Males. 


Females. 


Age Period. 


M. L. I. Co. 
(White). 


U. S. Reg. 
Area. 


M. L.I. Co. 

(White). 


U. S. Reg. 
Area. 


1 to 4 


48.8 

12.5 
4.5 


41.9 

10.8 

4.5 


49.1 

13.0 

4.9 


40 


5 to 9 


10.7 


10 to 14 


5.0 













Like pulmonary tuberculosis, tuberculous meningitis shows a 
very favorable trend in its incidence during recent years. In the 
age period one to four years the rate for white males for the two 



62 



MORTALITY STATISTICS OF INSURED WAGE EARNERS. 



years 1911 and 1912 was 51.5 and, for 1915 and 1916 combined, it 
was only 46.0 per one hundred thousand. The per cent, decline 
was, therefore, 10.7. The greatest decline among the insured ap- 
pears to have occured among white females, where the rate for 
1915 and 1916 was 18.0 per cent, lower than that for 1911 and 1912 
combined. 

Abdominal Tuberculosis. 
Abdominal tuberculosis is the third form of tuberculous disease 
of interest in this discussion. "We have included in our figures 
deaths from tuberculosis of the gastroenteric tract, including the 
peritoneum, the omentum and the mesenteric glands. In all, there 
were 3,155 such deaths. Deaths from this disease seem to be fairly 
well distributed over the entire range of life. The variation in the 
death rate from one age period to another is not so marked as was 
observed for pulmonary tuberculosis or for tuberculous meningitis. 
There appear to be in this present series of data three points of 
modal incidence, the first at the age period one to four years, the 
second in the age period 35 to 44 years and the third after age 75. 
Between each of these points the curve tends to assume a concave 
form. The least rate was registered in the age period ten to four- 
teen years. Our facts according to color, sex and age period are 
displayed in the following table: 

TABLE 25. 
Mortality from Abdominal Tuberculosis, Classified by Color, Sex and 

Age Period. 

Death 'Rates Fer 100,000 Persons Exposed. 1911 to 1916. 

Experience of Metropolitan Life Insurance Company. Industrial 

Department. 





Persons. 


White. 


Colored. 


Age Period. 


Males. 


Females. 


Males. 


Females. 


All ages — one and 
over 


5.9 


3.7 


4.6 


15.4 


19 6 






lto4 

5 to 9 

10 to 14 

15 to 19 

20 to 24 

25 to 34 

35 to 44 

45 to 54 

55 to 64 

65 to 74 

75 and over . . . 


6.8 
3.4 
3.2 
5.3 
6.4 
6.7 
7.9 
6.3 
7.6 
8.4 
10.6 


6.2 
2.2 
1.1 
2.2 
3.2 
3.9 
5.2 
5.4 
7.7 
8.4 
8.5 


5.2 
2.1 
2.3 
3.4 
5.3 
5.1 
6.5 
5.5 
5.9 
7.7 
11.7 


28.2 
16.9 
14.2 
19.8 
17.1 
13.4 
13.8 
10.7 
16.2 
6.7 


14.6 
18.2 
21.1 
32.8 
23.8 
19.8 
18.6 
11.3 
13.6 
16.4 
18.1 



TUBERCULOSIS. 



63 



The colored show higher death rates in this series than do the 
whites, and the rate for females of each color group exceeds that 
for the males. 

Among white lives, there is no great difference between the rates 
of the two sexes under ten years of age. Beginning with the age 
period ten to fourteen years, however, the death rates for abdominal 
tuberculosis among white females begin to exceed the rates for white 
males to a significant extent, up to and including the period thirty- 
five to forty-four years. This suggests the influence of puerperal 
traumata as causes contributing to the development of abdominal 
tuberculosis. For the period forty-five to fifty-four years, the rates 
for both sexes for white lives are approximately the same. After 
fifty-Sve years of age, the figures for white males exceed those for 
white females up to and including age seventy-four. 

White males and white females show in general a decreasing 
death rate from abdominal tuberculosis in this experience. Col- 
ored males, however, show a variable rate with no definite tendency 
in either an upward or downward direction. There seems to be 
only a slight downward tendency in the death rate from abdominal 
tuberculosis among colored females. These facts are displayed in 
the following table: 

TABLE 26. 

Mortality from Abdominal Tuberculosis, Classified by Color and 

BY Sex. 

Death Bates Per 100,000 Persons Exposed. Single Years in Period 1911 

to 1916. 

Experience of Metropolitan Life Insurance Company. Industrial 

Department. 





Persons. 


White. 


Colored. 


Year. 


Males. 


Females. 


Males. 


Females. 


1911 to 1916 


5.9 


3.7 


4.6 


15.4 


19.6 


1916 


5.1 
5.2 
5.5 
6.2 
6.6 
6.9 


3.2 
3.3 
2.9 
3.7 

4.8 
4.6 


3.7 
4.0 
4.6 
5.1 

4.8 
5.8 


15.3 
14.5 
14.3 
17.1 
17.0 
14.3 


18.4 


1915 


18.6 


1914 


20.0 


1913 


19.2 


1912 


20.6 


1911 


21.1 



Comparison of the death rates for abdominal tuberculosis among 
white insured persons and among persons in the Eegistration Area 
shows some items of interest. These are displayed in the following 
table : 



64 



MOETALITY STATISTICS OF INSURED WAGE EARNEKS. 



TABLE 27. 

Mortality from Abdominal Tuberculosis. 

Death Bates Per 100,000 Persons Exposed. Classified hy Sex and by Age. 

Insured White Lives in Experience of Metropolitan Life Insurance Company, 

Industrial Department (1911 to 1916) and General Population of 

Expanding Registration Area of the United States 

(1910 to 1915). 





Males. 


Females. 


Age Period. 


M. L. I. Co. 
(VFWte). 


U. S. Reg. 
Area. 


Per Cent. 
M. L. I. Co. 
of Reg. Area. 


M. L. I. Co. 

(WWte). 


U. S. Reg. 
Area. 


Per Cent. 
M. L. I. Co. 
of Reg. Area. 


AH ages — one 
and over . . 


3.7 


4.8 


77.1 


4.6 


6.0 


76.7 


1 to 4 


6.2 


6.9 


89.9 


5.2 


5.3 


98.1 


5 to 9 


2.2 


2.7 


81.5 


2.1 


2.2 


95.5 


10 to 14 


1.1 


1.9 


57.9 


2.3 


2.6 


88.5 


15 to 19 


2.2 


3.3 


66.7 


3.4 


5.1 


66.7 


20 to 24 


3.2 


4.4 


72.7 


5.3 


6.9 


76.8 


25 to 34 


3.9 


4.6 


84.8 


5.1 


7.2 


70.8 


35 to 44 


5.2 


4.9 


106.1 


6.5 


7.0 


92.9 


45 to 54 


5.4 


5.6 


96.4 


5.5 


6.9 


79.7 


55 to 64 


7.7 


8.4 


91.7 


5.9 


9.1 


64.8 


65 to 74 


8.4 


10.4 


80.8 


7.7 


10.4 


74.0 


75 and over. . 


8.5 


7.6 


111.8 


11.7 


10.6 


110.4 



It is a matter of great interest that the male mortality for the 
general population of the Eegistration Area exceeds that for white 
males in the insurance experience. The only exception is in the 
age group 35 to 44 years and beyond age 75. Among females, 
the population rates are in excess of those for the insurance ex- 
perience for all age periods except 75 years and over. The least 
ratio of excess is to be observed in the age period 1 to 4 years. 

Tuberculosis of Other Forms, and Disseminated Tuber- 
culosis. 

We did not deem it desirable to bring out in any great detail 
the facts for the remaining forms of tuberculosis registered in our 
mortality records. In addition to mortality from the forms of 
tuberculosis which have been discussed in the preceding sections, 
we recorded 2,655 deaths from tuberculous infection of other or- 
gans. These deaths occurred at a rate of 4.9 per 100,000 exposed. 
According to our records, there was a gradual decrease in deaths 
from these miscellaneous forms of tuberculosis, from a rate of 5.8 
per 100,000 in 1911 to a rate of 4.1 in 1916. 



CHAPTEE V. 

Organic Diseases of the Heaet. 

The deaths classified as due to "organic diseases of the heart" 
form a group which is second in numerical importance only to 
tuberculosis in this mortality experience of insured wage earners. 
In the experience of the general population of the expanding Reg- 
istration Area in recent years, organic heart disease has ranked 
first as a cause of death. During the six-year period, 1911 to 1916, 
75,345 deaths from organic cardiac diseases were recorded among 
the Company's Industrial policyholders. This number is 11.9 per 
cent, of the 635,449 deaths from all causes. The deaths corre- 
spond to a rate of 140.1 per 100,000 exposed. This is for the en- 
tire experience period ; but in four of the six years the rate was 
higher than that for the period as a whole. 

The chief interest in connection with the study of the mortality 
from cardiac disease lies, of course, in its variable age, color and 
sex incidence. The disease is primarily one of advanced life, 
although, as we shall see, it takes a significant toll at the younger 
adult ages. The rate is considerably higher among colored persons 
than among the white group, which condition also obtained in the 
Registration Area for the period as a whole and for each included 
year. This was true for each sex for every significant age group 
with the exception of that relating to decedents 75 years of age 
and over. 

The death rates are very different for the two sexes. Almost 
without exception the rates for females are higher than for males 
up to and including the age period 20 to 24 years. After this age 
period, however, the situation is reversed, the death rates for males 
being very much higher than for females. This is uniformly true 
for white lives but there are a few exceptions among the colored. It 
would appear, therefore, that these organic heart diseases in their 
higher incidence among adult males strike heavily at the chief or 
only income producers of families ; often after long periods of sick- 
ness in which the wage earner has been unable to work actively all 
or part of the time. These diseases thus bring about hardship and 
6 65 



66 



MORTALITY STATISTICS OP INSURED WAGE EARNERS. 



distress which can not be shown in figures. In fact, if it were pos- 
sible to calculate the money loss to the country through deaths from 
the heart affections and the long periods of sickness which precede 
them, the importance of cardiac disease economically would be 
much more impressively demonstrated than is possible by the publi- 
cation of mere numbers of deaths and the corresponding death 
rates. 

Considered irrespective of color or sex, we find that the death 
rates for the organic diseases of the heart increase regularly with 
age, but show their greatest increases in the higher age periods. 
This is brought out clearly in the following table and in the ac- 
companying graph : 

TABLE 29. 

Mortality from Organic Diseases of the Heart, Classified by Color, 
Sex and by Age Period. 

Death Bates per 100,000 Persons Exposed. 1911 to 1916. 

Experience of Metropolitan Life Insurance Company. Industrial 
Department. 





Persons. 


White. 


Colored. 


Age Period. 


Males. 


Females. 


Males. 


Females. 


All ages — one and 
over 


140.1 


125.9 


137.0 


191.0 


202 






lto4 

5 to 9 

10 to 14 

15 to 19 

20 to 24 

25 to 34 

35 to 44 

45 to 54 

55 to 64 

65 to 74 

75 and over.. 


7.3 

16.2 

26.7 

30.2 

30.6 

53.5 

121.8 

253.6 

604.8 

1523.1 

2808.1 


7.0 

14.9 

22.7 

28.7 

28.5 

51.6 

120.1 

259.0 

641.2 

1624.2 

3033.1 


6.4 

18.2 

31.4 

31.2 

30.4 

45.6 

92.6 

201.1 

526.8 

1443.0 

2703.1 


14.1 

11.4 

19.9 

29.4 

32.2 

89.6 

201.2 

416.0 

885.4 

1702.2 

2647.8 


14.6 

14.1 

28.3 

34.9 

42.8 

72.8 

211.7 

433.1 

787.8 

1530.3 

2613.2 



Significant relations may be brought out by comparing the fore- 
going figures for white persons with those for the total expanding 
Eegistration Area of the United States. We shall use for this pur- 
pose the population figures for the six year period 1910 to 1915 
inclusive. Taking all ages one and over together in the two expe- 
riences, we find that the mortality rate for insured white males 
(135.9 per 100,000) was lower than that for males of the Registra- 
tion Area (147.0 per 100,000) and that the rate for insured white 



ORGANIC DISEASES OF THE HEART. 



67 



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68 



MORTALITY STATISTICS OF INSUEED WAGE EARNERS. 



females (137.0) was lower than the rate for females in the general 
population (140.7). No mistake should be made, however, as to 
the meaning of these figures. The apparent advantage in favor of 
the insured group results simply from their more favorable age 
distribution. A larger proportion of them are in the younger age 
groups where the death rate from the heart diseases is low, and 
only a small proportion of the policyholders are found in the ad- 
vanced ages when the death rate from these conditions is very high. 
A comparison between the two series must, therefore, be strictly 
limited to each age period and to each of the sex groups, separately. 
The following table shows, side by side, the figures for males in 
the expanding Eegistration Area compared with those for insured 
white males and for females in the Eegistration Area compared 
with insured white females: 



TABLE 30. 

Mortality from Organic Diseases of the Heart. 
Death Bates per 100,000 Persons Exposed. Classified hy Sex and by Age 
Period. Insured White Lives in Experience of Metropolitan Life In- 
surance Company, Industrial Department {1911 to 1916) and 
General Population Experience of Expanding Registra- 
tion Area of the United States (1910 to 1915). 





Males. 


Females. 


Age Period. 






Percentage 






Percentage 




M. L. I. Co. 


U. S. Reg. 


M. L. I. Co. 


M. L. I. Co. 


U. S. Reg. 


M. L.I. Co. 




(White). 


Area. 


of Keg. Area. 


(White). 


Area. 


of Reg. Area. 


AH ages — one 














and over . . . . 


125.9 


147.0 


85.6 


137.0 


140.7 


97.4 


1 to4 


7.0 


7.6 


92.1 


6.4 


7.6 


84.2 


5 to 9 


14.9 


12.6 


118.3 


18.2 


15.3 


119.0 


10 to 14.... 


22.7 


16.6 


136.7 


31.4 


21.2 


148.1 


15 to 19.... 


28.7 


19.7 


145.7 


31.2 


20.4 


152.9 


20 to 24.... 


28.5 


20.0 


142.5 


30.4 


23.0 


132.2 


25 to 34.... 


51.6 


33.4 


154.5 


45.6 


36.9 


123.6 


35 to 44.... 


120.1 


76.0 


158.0 


92.6 


76.8 


120.6 


45 to 54.... 


259.0 


175.5 


147.6 


201.1 


160.9 


125.0 


55 to 64.... 


641.2 


474.4 


135.2 


526.8 


409.2 


128.7 


65 to 74.... 


1624.2 


1213.8 


133.8 


1443.0 


1044.1 


138.2 


75 and over 


3033.1 


2665.6 


113.8 


2703.1 


2438.6 


110.8 



Thus compared, a very different picture is presented, for, with 
the single exception of the period of early childhood, namely, 1 to 
4 years, the death rates are much higher for the insured group than 



ORGANIC DISEASES OF THE HEART. 69 

for the general population. It is especially at the working agos of 
life that the disadvantage of the policyholders is evident. The facts 
of mortality from organic diseases of the heart, as for tuberculosis, 
show with advancing age the cumulative effect upon the vitality of 
wage earners of more severe conditions of life and work, and per- 
haps of less favorable hygienic circumstances, than are found in 
the general population of the United States. 

This conclusion is apparently substantiated when we compare 
the relation between the death rates of the two sexes in the popula- 
tion and in the insured group. We find, for example, in the twenty 
year age period, from 25 to 45 years, very much higher rates for 
males than for females in the wage earning element. On the other 
hand, in the general population, females at these ages do not enjoy 
any such advantage ; in fact, the rates are slightly higher for them 
than for the males. This would seem to be the result of the severer 
strain of life and work to which male wage earners are exposed. 

The trend of the death rate from organic heart diseases in the 
Industrial Department of the Metropolitan Life Insurance Com- 
pany during the six years is interesting and is in marked contrast 
with the tendency shown by the figures of the general population. 
In the insurance figures the rate for 1916 is lower than for 1911 
(140.2 as compared with 141.8). This represents a decline of 1.1 
per cent, in the period. On the other hand, in the expanding Reg- 
istration Area the figures show a very considerable increase in the 
six year period from 140.9 in 1911 to 150.1 per 100,000 in 1916 
(6.5 per cent.). It is quite true that in both experiences there is 
a certain irregularity in the trend; but the rates for the insured 
group, very generally speaking, show downward tendency, whereas 
those for the population, especially since 1913, show a continuous 
rise. The changes that have occurred in the population figures are 
even more strikingly brought out when we go back a number of 
additional years. In 1900 the Eegistration Area rate was only 
111.2 per 100,000; by 1904 it had, through continuous increases, 
reached 133.4. From that year until 1911 there was considerable 
fluctuation; the 1911 rate (140.9) marked a 26,7 per cent, increase 
over the figure for 1900. 

The following table presents the trend of mortality among in- 
sured wage earners in the years 1911 to 1916: 



70 



MOETALITY STATISTICS OF INSURED WAGE EAENEES. 



TABLE 31. 

Mortality from Obganic Diseases of the Heabt, Classified bt Color 

AND BY Sex. 

Death Bates per 100,000 Persons Exposed. Single Years in Period 1911 

to 1916. 

Experience of Metropolitan Life Insurance Company. Industrial 

Bepartment. 





Persons. 


White. 


Colored. 


Year. 


Males. 


Females. 


Males. 


Females. 


1911 to 1916 


140.1 


125.9 


137.0 


191.0 


202.0 


1916.... 
1915.... 
1914.... 
1913.... 
1912.... 
1911.... 


140.2 
136.7 
138.1 
140.6 
143.8 
141.8 


126.0 
119.4 
125.5 
127.3 
129.4 
128.8 


135.8 
136.1 
134.6 
137.2 
139.5 
139.9 


197.2 
183.9 
191.5 
194.6 
202.6 
175.5 


212.9 
207.1 
193.1 
193.9 
205.7 
198.7 



The increase in mortality from organic heart diseases which we 
have just discussed for the Eegistration Area has, in recent years, 
given rise to the prevalent opinion that there has heen a marked 
increase in the so-called "degenerative diseases." Certainly this 
conclusion is not substantiated by the facts presented by the mor- 
tality data for insured wage-earners. If, however, we limit our- 
selves to a consideration of the expanding Eegistration Area alone, 
we should keep in mind that even these data with their marked in- 
creases in the interval since 1900 must not be taken on their face 
as final. The Census Bureau itself has continually cautioned the 
readers of its reports on Mortality Statistics against comparing the 
more recent figures for organic diseases of the heart with those run- 
ning prior to 1910. Very important changes in the statistical 
treatment of this return of cause of death have been instituted by 
the Census Bureau. Certain statements of cause, such as, " endo- 
carditis" and "myocarditis" for decedents over 60 years of age 
which were formerly excluded from this title are now classified 
under it. Methods of treating jointly reported causes of death as 
well as the accelerated tendency of physicians to report more defi- 
nitely the conditions causing death, have undoubtedly resulted in 
the increased reporting of organic diseases of the heart. The evi- 
dence, therefore, is clear that a large part, at least, of the increase 
in the death rate of the heart diseases is fictitious, resulting merely 



OKGANIC DISEASES OF THE HEAET. 71 

from changed reporting and compiling procedure; and so far as 
this concerns insured wage earners where the greatest amount of 
increase might be expected, it does not show at all. 

Organic diseases of the heart, International List title No. 79, as 
compiled in this report, include all chronic valvular diseases, fatty 
degeneration, chronic myocarditis and chronic dilatation. It in- 
cludes a number of deaths which are ascribed by physicians to 
" heart disease " without further definition. It also comprehends 
chronic heart diseases of rheumatic origin. On the other hand, the 
title does not include acute endocarditis, acute myocarditis, " endo- 
carditis " or " myocarditis " with no further qualification, for dece- 
dents under 60 years of age. Deaths reported as due to pericar- 
ditis and those reported as due to many indeterminate cardiac 
symptoms such as "palpitation of the heart," "functional disease 
of the heart" and others are not included. 



CHAPTEE VI. 

Pneumonia (All Forms). 

Pneumonia, as the term is popularly used, is a most important 
cause of death in this experience, the incidence of which has been 
increasing significantly during recent years. Unfortunately, the 
term has no great scientific value since it is used, in the main, to 
cover two very different conditions, namely, lobar pneumonia and 
bronchopneumonia. Lobar pneumonia is a disease affecting, for 
the most part, the adult ages of life. Bronchopneumonia, on the 
other hand, is a disease affecting chiefly the periods of childhood 
and old age. In fact, two-thirds of all the deaths in the general 
population experience from bronchopneumonia are those of chil- 
dren under five years of age. For these reasons and because of the 
different clinical pictures presented by these two conditions, it will 
be much more instructive to treat in detail each of the types of 
pneumonia separately. At this point it is necessary only to remark 
that in the period between 1911 and 1916 the total number of 
deaths from "pneumonia (all forms) " was 57,931 ; this is the total 
for lobar pneumonia, so defined, bronchopneumonia and "pneu- 
monia" without further qualification. Together the death rate 



TABLE 32. 

MOBTALITT FROM PNEUMONIA (ALL FORMS), PNEUMONIA (LOBAR AND UN- 
DEFINED) AND Bronchopneumonia. 
Death Bates per 100,000 Persons Ex-posed. Single Years in Period 1911 

to 1916. 

Experience of Metropolitan Life Insurance Company. Industrial 

Department. 



Year. 


" Pneumonia (AH 
Forms)." 


Pneumonia (Lobar and 
Undefined) . 


Bronchopneumonia. 


1911 to 1916 


107.7 


77.5 


30.2 


1916 

1915 

1914 

1913 

1912 

1911 


114.3 
106.5 
100.3 
106.1 
103.9 
115.3 


80.8 
74.4 
68.9 

77.7 
75.8 
89.2 


33.5 
32.1 
31.4 

28.4 
28.1 
26.1 



72 



PNEUMONIA. 73 

for the six year period was 107.7 per 100,000 exposed. The preced- 
ing figures show the trend in the rate for this large group of causes 
of death since 1911. 

(a) Pneumonia (lobar and undefined). 

Statistics of mortality from pneumonia (lobar and undefined) 
are interesting from many standpoints. Lobar pneumonia is the 
most important numerically of the infectious diseases. It kills 
every year more people than die of such infectious diseases as 
measles, scarlet fever, diphtheria, whooping cough and acute polio- 
myelitis combined. Any one stricken with lobar pneumonia, more- 
over, has a smaller chance of recovery than have those afflicted 
with any one of the other conditions just mentioned — even polio- 
myelitis or "infantile paralysis." Several health departments 
have, therefore, placed lobar pneumonia on the list of reportable 
diseases, thus officially recognizing the fact of its infectiousness and 
calling attention to its extremely fatal nature. 

During the six-year period 1911 to 1916, in this experience, 
41,707 insured wage earners and members of their families died 
of pneumonia (lobar and undefined). The death rate correspond- 
ing to this number of deaths was 77.5 per 100,000. This group 
of diseases shows a higher death rate among colored policyholders 
than among the white. The table on page 74 shows also that 
these facts are true both for males and females. The ages of high- 
est mortality are the extremes of life. This applies to both white 
and colored persons and to males and females. The excess of col- 
ored over white mortality is shown in every age period for both 
males and females. 

Further consideration of this table shows that the rate for males 
is almost uniformly higher than that for females. There are, to 
be sure, two exceptions among white lives, one at ages 10 to 14 
years, the other at the very advanced age period 75 years and over, 
but in both cases the difference between the two sexes is slight and 
does not materially affect the conclusion drawn. Beginning with 
the period 25 to 34 years and continuing up to 65 to 74 years, the 
rate for males is much in excess over the rate for females ; in fact, 
for a number of these age periods the rate for males is more than 
twice that of females. Much the same conclusion may be drawn 
from the comparison of the rates for the two sexes of the insured 



74 



MOETALITY STATISTICS OF INSURED WAGE EARNERS. 



TABLE 33. 

Mortality feom Pneumonia (Lobar and Undefined), Classified by 

Color, Sex and by Age Period. 

Death Bates per 100,000 Persons Exposed. 1911 to 1916. 

Experience of Metropolitan Life Insurance Company. Industrial 

Department. 





Persons. 


White. 1 Colored. 




Males. 


Females. 


Males. 


Females. 


All ages — one 
and over 


77.5 


82.6 


63.0 


141.5 


97.2 


1 to 4 

5 to 9 

10 to 14 

15 to 19 

20 to 24 

25 to 34 

35 to 44 

45 to 54 

55 to 64 

65 to 74 

75 and over. . 


108.0 

19.7 

11.5 

20.8 

29.5 

50.1 

89.7 

139.6 

247.9 

468.7 

791.3 


103.5 

17.9 

9.5 

19.4 

29.0 

62.6 

130.9 

197.4 

300.7 

500.0 

774.6 


93.2 

17.5 

10.8 

14.6 

17.9 

29.4 

50.8 

92.7 

203.3 

441.1 

794.4 


240.4 

32.8 

22.8 

52.4 

94.0 

119.8 

175.2 

242.7 

346.4 

542.9 

836.9 


232.2 

47.6 

24.9 

51.8 

60.5 

55.8 

86.2 

126.9 

251.8 

482.7 

834.8 



colored group, although the differences are not, on the whole, as 
great as those observed among the whites. The charts on page 
75 graphically illustrate these facts for pneumonia mortality ac- 
cording to age. 

The rate already noted for the entire experience, namely, 77.5 
per 100,000, is somewhat more favorable than that found in the 
expanding Registration Area of the United States for the six-year 
period 1910 to 1915. This condition is still in evidence when the 
estimated population of the Area under one year of age is elimi- 
nated, and the rates are computed for persons of the same age 
groups as those covered by the insurance experience. Thus, we 
find that in the six-year period 1910 to 1915 the population rate for 
males was 84.3 per 100,000, while the rate for females was 66.6. 
These compare with the policyholders' figures of 82.6 and 63.0 
for insured white males and white females respectively. The gen- 
eral population figures would be somewhat lower if it were possible 
to eliminate the effect of the colored element which is included. 
This cannot be done but it is evident that the exposures in the two 
experiences are, by and large, in very close agreement. 

An analysis by age groups shows, however, a number of impor- 
tant points of difference when we compare the experience in the 



PNEUMONIA. 



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76 



MORTALITY STATISTICS OF INSURED WAGE EARNERS. 



general population with that of the insured. We find, for example, 
that for males, the general population rates are somewhat higher 
until central age 22.5 is reached. At this point there is a sharp 
upward trend in the experiences — much more pronounced, how- 
ever, among white male policyholders than in the general popula- 
tion — so much so that the rate in the next age period for white 
male policyholders is considerably in excess of that for males in 
the general population. Comparing females, we find that white 
female policyholders enjoyed an advantage up to and including 
the age period 20 to 24 years. Thereafter they show, without 
exception, higher rates, although the differences are not as great 
as those we recounted for the males. 

In both experiences- the age group of maximum mortality is the 
period 75 years and over and the minimum mortality occurs in the 
age period 10 to 14 years. The following table presents the facts 
by sex and age period for the expanding Eegistration Area with- 
out distinction of color, and for white males and white females in- 
sured in the Industrial Department of the Company: 



TABLE 34. 

Mortality from Pneumonia (Lobar and Undefined). 

Death Bates per 100,000 Persons Exposed. Classified by Sex and by Age 
Period. Insured White Lives in Experience of Metropolitan Life In- 
surance Company, Industrial Department {1911 to 1916) and 
General Population Experience of Expanding Registra- 
tion Area of the United States (1910 to 1915). 





Malea. 


Females. 


Age Period. 


M. L. I. Co. 


U. S. Reg. 


Percentage 
M. L.I. Co. 


M. L. I. Co. 


V. S. Reg. 


Percentage 
M. L. I. Co 




(White). 


Area. 


of Reg. Area. 


(WMte). 


Area. 


of Reg. Area. 


All ages — one 














and over .... 


82.6 


84.3 


98.0 


63.0 


66.6 


94.6 


1 to4 


103.5 


110.4 


93.8 


93.2 


97.3 


96.8 


5 to 9 


17.9 


19.5 


91.8 


17.5 


17.8 


98.3 


10 to 14.... 


9.5 


11.4 


83.3 


10.8 


12.0 


90.0 


15 to 19.... 


19.4 


24.6 


78.9 


14.6 


16.1 


90.7 


20 to 24.... 


29.0 


33.1 


87.6 


17.9 


19.9 


89.9 


25 to 34.... 


62.6 


46.2 


135.5 


29.4 


29.0 


101.4 


35 to 44.... 


130.9 


81.7 


160.2 


50.8 


43.7 


116.2 


45 to 54.... 


197.4 


127.4 


154.9 


92.7 


73.7 


125.8 


55 to 64.... 


300.7 


204.4 


147.1 


203.3 


155.6 


130.7 


65 to 74.... 


500.0 


344.9 


145.0 


441.1 


336.2 


131.2 


75 and over. 


774.6 


701.0 


110.5 


794.4 


785.8 


101.1 



PNEUMONIA. 77 

It is to be observed that many of the age characteristics discussed 
in the section on pulmonary tuberculosis are to be noted in these 
data for pneumonia (lobar and undefined). For both these diseases 
the period 1 to 4 years is one of very high incidence. The rates 
decline to a minimum in the age period 10 to 14 years and there- 
after increase rapidly, reaching the maximum at the highest age 
period rather than at the period of middle adult life as in tuber- 
culosis. Beginning with the age period 55 to 64 years for females 
and 65 to 74 years for males, the rates for pneumonia (lobar and 
undefined) are considerably higher than those for pulmonary 
tuberculosis. 

The trend of the death rate for pneumonia in recent years 
has been somewhat disquieting. The highest death rate in the 
Metropolitan experience was found in 1911 (89.2). The lowest 
was for the year 1914 (68.9). Since 1914 there has been a distinct 
increase in the mortality rate, which rose to 74.4 in 1915 and still 
higher, to 80.8, in 1916. Much the same picture is presented by the 
figures for the Eegistration Area. The year of maximum mortal- 
ity in the population figures, 89.3, was also 1911. The minimum 
was reached in 1914 and the same general tendency toward a rise 
is observable in later years. It is quite possible that the rates in 
both experiences for 1911 are higher than they should be because 
our inquiry system was not as effective in the early years of this 
investigation as in the later years when many cases of so-called 
" pneumonia " were charged to bronchopneumonia or to other more 
definitely described diseases as a result of the supplementary state- 
ments of physicians. 

The above suggests that it may be advisable to discuss with some 
fullness the routine followed in this office in assigning deaths re- 
ported as due to "pneumonia." In every instance in which the 
case was returned certified as due to "pneumonia," a letter was 
sent to the physician containing one of the following inquiries: 

(a) QuEEY FOE Deaths of Childeen Undee 15 Yeaes of Age : 

Does the word "pneumonia" as used by you refer to lobar, bronchial, 
grippal, or tuberculous pneumonia? Following any contagious disease 
(measles, whooping cough, scarlet fever, etc.)? Traumatic? If so, means 
and nature of injury? 

(&) Othee Deaths: 

Does the word "pneumonia" as used by you refer to lobar, bronchial, 
grippal, or tuberculous pneumonia? Was it traumatic? If so, was death 



78 MORTALITY STATISTICS OF INSUEED WAGE EAKNEKS. 

due to suicide, homicide or accident, and if the last, what kind of accident 
was the primary cause of death (steam railroad^ street car, fall, etc.) ? 

As a result of these inquiries, it is safe to say that thousands of 
cases have been definitely established as due either to the lobar or 
bronchial form of the disease. Those due to the bronchial form 
were so classified; those definitely ascribed as due to the "lobar" 
form were included in the 41,707 deaths previously referred to in 
this section of the report. It is safe to say that not less than ninety 
per cent, of these deaths were actually caused by true lobar pneu- 
monia; the remaining cases included deaths that were certified as 
caused by pleuropneumonia, double pneumonia, and more com- 
monly by "pneumonia," where no additional information could be 
obtained. We feel confident in the safety of this estimate because 
in the returns of the Bureau of the Census the proportion of lobar 
pneumonia actually recorded under this title was 87 per cent., in 
recent years. The inquiry system applied to the returns of the 
present study has covered a higher proportion of such reports 
during the period than that carried on by the Census Bureau dur- 
ing the same period. This fact would undoubtedly result in a 
larger proportion of cases properly classified as true lobar pneu- 
monia. 

(b) Beonchopneumonia. 

Sixteen thousand, two hundred and twenty-four (16,224) deaths 
from bronchopneumonia occurred in this experience during the six- 
year period 1911 to 1916. The death rate was 30.2 per 100,000 
exposed. 

Color, Sex and Age Incidence. 

The death rate of the colored policyholders, both male and fe- 
male, exceeded that of the white group. This is true of each sex 
class for each year of the period with the- exception of the year 
1912, for which the mortality among white females (27.7) was very 
slightly higher than that of colored females (27.5). There is, 
according to the Metropolitan experience for the sexennium as a 
whole, very little difference between the death rates of the two sexes 
for this disease. The rate at all ages for white males (29.6) ex- 
ceeds only very slightly that for white females (29.2), while that 
for colored males at all ages (37.7) is not much higher than for 
colored females (33.7). Of the 16,224 deaths among Metropolitan 
policyholders, 7,007, or 43 per cent., were those of children between 



PNEUMONIA. 79 

1 and 5 years of age. If this proportion is less than that in the 
population at large, it is because the first year of life is excluded 
among the insured and this is an age of heavy incidence for bron- 
chopneumonia. The number of deaths in this age period far ex- 
ceeded that of any other age group, although the death rate (155.3) 
is not as high as that for either of the periods 65 to 74 years or 75 
years and over (185.3 and 436.9 respectively). There was, of 
course, a far greater number of living policyholders during the 
earlier period. 

Further analysis of the mortality for bronchopneumonia by age 
groups brings out a number of rather interesting phenomena. 
Among white males the death rate for the period 1 to 4 years was 
145.4; the corresponding figure for white females was 139.9. In 
this, the most significant age group, the proportion of deaths of 
males to those of females was somewhat heavier than that indicated 
by the death rates for white males (29.6) and of white females 
(29.2) at all ages. In the next age period 5 to 9 years, on the 
other hand, a higher rate among white persons is shown for fe- 
males (13.0) than for males (11.5). Indeed, for each of the next 
three age periods the rate for females is slightly in excess of that 
for males. When the age group 25 to 34 years is reached this con- 
dition changes and more or less pronounced excesses are shown for 
white males for the groups 25 to 34, 35 to 44, 45 to 54 and 55 to 
64 years. In the two highest age groups, we find the mortality 
among white females, again, to be higher than that for white males. 
Since the number of deaths that occurred and the number of per- 
sons exposed is large enough to be significant, these sex character- 
istics of bronchopneumonia mortality among white policyholders 
are exceedingly interesting. 

The sex distribution of the mortality among colored policyhold- 
ers is less significant on account of the much smaller number of 
deaths involved and of persons exposed, but in many respects it 
corresponds with that of the white policyholders. The death rate 
among colored males for the period 1 to 4 years (329.4) is higher 
than that for colored females (317.9) ; for the next two age periods 
the higher rates are shown for colored girls. For the age period 
15 to 19 years the experience was contrary to that among white 
policyholders, for the death rate for males (12.5) exceeded that for 
females (10.3). From this age period to the higher age periods 



80 



MORTALITY STATISTICS OF INSURED WAGE EARNERS. 



the sex ratio of bronchopneumonia mortality is practically the same 
for colored persons as for the whites,, except that in the highest 
age group the excess of the rate for females, over that for males is 
much smaller among colored persons than for the corresponding 
age period among white persons. The number of deaths involved 
in this last age group, however, is small, as indeed, are the num- 
bers in several of the age periods. 

The following table and chart show the death rate for broncho- 
pneumonia per 100,000 persons exposed by certain specified age 
groups for all policyholders and for white and colored policyhold- 
ers by sex, for the period 1911 to 1916. 

TABLE 35. 

MORTAUTT FROM BeONCHOPNETJMONIA, CLASSIFIED BY COLOR, SeX AND BY 

Age Period. 

Death Bates per 100,000 Persons Exposed. 1911 to 1916. 

Experience of Metropolitan Life Insurance Company. Industrial 

Department. 





Persons. 


White. 


Colored. 


Age Period. 


Males. 


Females. 


Males. 


Females. 


All ages — one and 
over 


30.2 


29.6 


29.2 


37.7 


33.7 






1 to4 

5 to 9 

10 to 14 

15 to 19 

20 to 24 

25 to 34 

35 to 44 

45 to 54 

55 to 64 

65 to 74 

75 and over. . 


155.3 

13.4 

3.3 

3.7 

4.0 

6.4 

11.2 

23.3 

62.2 

185.3 

426.9 


145.4 

11.5 

2.7 

2.6 

2.8 

6.7 

14.0 

29.0 

65.0 

173.1 

350.4 


139.9 

13.0 

3.1 

2.9 

3.3 

4.6 

8.2 

18.2 

60.6 

202.7 

484.7 


329.4 

25.0 

6.0 

12.5 

10.2 

12.4 

18.4 

31.3 

69.0 

113.6 

343.0 


317.9 

26.2 

9.0 

10.3 

10.3 

9.4 

11.1 

26.2 

56.8 

153.9 

344.8 



The death rate for this disease for the year 1911 was 26.1 and a 
continuous increase is shown throughout the sexennium. The 
maximum mortality, that of the year 1916, was 33.5 per 100,000. 
The death rates for the several years of the period are much 
lower than those for the corresponding years in the expanding 
Eegistration Area, but the increasing mortality is in evidence for 
both experiences; it was not continuous, however, in the Eegistra- 
tion Area. In the latter experience, the 1914 rate was slightly 



PNEUMONIA. 



81 




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82 



MOKTALITT STATISTICS OF INSUEED WAGE EAENEES. 



lower than that for 1913, and the 1916 rate was lower than that for 
1915, The death rate for bronchopneumonia in the expanding 
Eegistration Area is higher than that for the group of insured 
wage earners because bronchopneumonia is a disease which takes 
its largest toll among infants under 1 year of age. The expanding 
Eegistration Area experience shows that about 40 per cent, of the 
mortality from this disease is that of infants under 1 year of age. 
It is also the cause of death of many thousands of people of 70 
years and over. Since there is no exposure among policyholders for 
the period of early infancy and a smaller proportionate exposure 
among elderly people than in the Eegistration Area, it is easy to 
account for the higher bronchopneumonia death rate of the latter 
group. In other words, the experiences are not comparable, so far 
as the crude death rates are concerned, on account of the differing 
age distributions of the two populations. 

The following table gives the death rates for bronchopneumonia 
for all policyholders, and for white and colored policyholders by 
sex, for the six-year period as a whole and for each year compre- 
hended. The upward trend of the mortality charged to this dis- 
ease is obvious. Chart IX graphically illustrates the data on the 
trend of bronchopneumonia mortality in this experience. 

TABLE 36. 
Mortality from Bronchopneumonia, Classified by Colob and by Sex. 
Death Bates per 100,000 Persons Exposed. Single Years in Period 1911 

to 1916. 

Experience of Metropolitan Life Insurance Company. Industrial 

Department. 





Persons. 


White. 


Colored. 


Year. 














Males. 


Females. 


Males. 


Females. 


1911 to 1916. 


30.2 


29.6 


29.2 


37.7 


33.7 


1916.... 


33.5 


32.7 


32.6 


43.3 


37.5 


1915.... 


32.1 


30.8 


31.2 


38.3 


41.8 


1914.... 


31.4 


31.1 


29.7 


39.9 


37.8 


1913.... 


28.4 


28.7 


26.8 


38.8 


29.3 


1912.... 


28.1 


27.7 


27.7 


34.4 


27.5 


1911.... 


26.1 


25.6 


25.8 


30.6 


26.9 



Since bronchopneumonia is a disease with a very pronounced age 
incidence, interest in comparing the mortality among wage earners 



PNEUMONIA. 



83 



Chart IX. — Mortality rrom Bronchopneumonia 

Death Rates per100,000Persons Exposed By Single Years 1911 to 1916 
Experience of Metropolitan Life Insurance Company, Industrial Department 
D««tli Rate 
par 100,000 




84 MOETALITT STATISTICS OF INSURED WAGE EARNEES. 

and their families with that among the general population attaches 
chiefly to the comparative mortality for the several age groups. In 
order to compare the death rate of young children it is, of course, 
necessary to eliminate the exposure under 1 year of age in the 
general population, since there is no corresponding exposure for 
the policyholders. For the age group 1 to 4 years the estimated 
death rate for bronchopneumonia among males in the Kegistration 
Area for the sexennium 1910 to 1915 was 143.3 per 100,000 popu- 
lation. This is lower than the corresponding rate for white males 
among the Industrial policyholders (145.4). It is believed, how- 
ever, that this slight difference is more than accounted for by the 
higher proportion of reports of cause of death in the insurance 
experience changed from "pneumonia" to bronchopneumonia as 
the result of information additional to that contained in the origi- 
nal certification and obtained through correspondence with the 
physicians who made the reports. Comparison by age groups 
shows, in every important instance, a higher mortality for the white 
male policyholders than for males in the general population, and 
this excess becomes more pronounced in the higher age periods. It 
is probable that a part of this excess in the rate for insured wage 
earners is real and represents the effect of their economic and sani- 
tary disadvantages. 

The age period of maximum mortality among males in the Reg- 
istration Area is shown to be the same as among the insured, 
namely, the highest age group, 75 years and over. In the general 
population experience, however, the lowest group, one to four years, 
shows a higher death rate than the group 65 to 74 years. This is 
contrary to the experience for the Industrial policyholders in that 
the death rate for white males for the age period 65 to 74 years 
(173.1) is considerably higher than that covering early childhood 
(145.4). 

The following table presents a comparison of the death rates for 
bronchopneumonia among insured lives and in the general popula- 
tion of the expanding Registration Area. 

While the chief interest in the mortality caused by bronchopneu- 
monia does not attach to the main wage earning periods, there are 
to be noted a few rather important differences in the ratios of the 
rates for males and of females which are in evidence in comparing 
the general population with the insurance experience on white lives. 
Beginning at the period 15 to 19 years, the death rate among the 



PNEUMONIA. 



85 



TABLE 37. 

Mortality from Bronchopneumonia. 
Death Bates per 100,000 Persons Exposed. Classified hy Sex and hy Age 
Period. Insured White Lives in Experience of Metropolitan Life In- 
surance Company, Industrial Department {1911 to 1916) and 
General Population Experience of Expanding Begistra- 
tion Area of the United States (1910 to 1915). 





Males. 


Females. 


Age Period. 


M. L. I. Co. 

(White). 


U. S. Reg. 
Area. 


Percentage 
M. L. I. Co. 
of Reg. Area. 


M. L. I. Co. 
(White). 


U. S. Reg. 
Area. 


Percentage 
M.L.I. Co. 
ol Reg. Area. 


All ages — one 
and over .... 


29.6 


26.9 


110.0 


29.2 


30.0 


97.3 


lto4 


145.4 


143.2 


101.5 


139.9 


134.5 


104.0 


5 to 9 


11.5 


10.9 


105.5 


13.0 


11.2 


116.1 


10 to 14.... 


2.7 


2.7 


100.0 


3.1 


3.7 


83.8 


15 to 19.... 


2.6 


2.9 


89.7 


2.9 


2.9 


100.0 


20 to 24.... 


2.8 


3.3 


84.8 


3.3 


3.6 


91.7 


25 to 34.... 


6.7 


4.7 


142.6 


4.6 


4.2 


109.5 


35 to 44.... 


14.0 


8.7 


160.9 


8.2 


6.5 


126.2 


45 to 54.... 


29.0 


16.0 


181.3 


18.2 


13.3 


136.8 


55 to 64.... 


65.0 


35.9 


181.1 


60.6 


39.5 


153.4 


65 to 74.... 


173.1 


94.1 


184.0 


202.7 


124.2 


163.2 


75 and over. 


350.4 


304.3 


115.1 


484.7 


430.0 


112.7 



general population is identical for males and females, namely, 2.9 
per 100,000 population. In the insurance experience that for 
females (also 2.9) exceeds slightly that for males (2.6). In the 
next age period (20 to 24 years), there is a slight excess in each 
experience in the rate for females, hut in the period 25 to 34 years, 
the white male insurance experience with a rate of 6.7 per 100,000 
exposed shows a much greater excess over the rate for insured white 
females (4.6) than is in evidence for the general population, for 
which the corresponding death rates were for males (4.7) and for 
females (4.2). The next age group shows higher rates for the 
males in each experience, hut the difference hetween the rates by 
sex is much greater among the insured (14.0 for white males as 
compared with 8.2 for white females) than among^ the general 
population (8.7 for males and 6.5 for females). For the period 
45 to 54 years with higher death rates (insured white males 29.0, 
white females 18.2; general population: males 16.0, females 13.3) 
there is, again, a greater divergence between mortality of males and 
females among the wage earning group than prevails for the popu- 
lation as a whole. When the age group 55 to 64 years is reached,^ 



86 MORTALITY STATISTICS OP INSUEED WAGE EAENERS. 

we find that the death rate for females in the general population 
exceeds that for the males (males 35.9, females 39.5), which is con- 
trary to the facts shown for the insured group (white males 65.0, 
white females 60.6; colored males, 69.0, colored females, 56.8). 

Reliability of the Figures for Bronchopneumonia Mortality. 

Death rates for bronchopneumonia should be used with caution. 
It will be noted that the figures indicating the mortality among 
insured wage earners from this disease show a continuous increase 
during the six years covered by this report. The rates for the 
expanding Registration Area also show an increase which was con- 
tinuous during the same period with the exception of two years, 
for each of which the deviation was too small to be significant. 
Prior to 1911 the published rates for the Registration Area were 
still lower than those for the period 1911 to 1916, and a superficial 
analysis of Registration Area experience would lead one to believe 
that in the seventeen years covered thereby there had been an 
increase in the mortality caused by this disease of 124 per cent. 
Briefly, it may be said that the increased published death rates for 
bronchopneumonia in both the insurance and general population 
experience have been brought about, first, by improved statements 
of cause of death on certificates and insurance forms, and second, by 
the ever-increasing strictness with which reports of "pneumonia,^' 
unqualified, are sent back to certifying physicians with requests for 
information as to the type of the disease. Still another matter 
should be considered in analyzing the published mortality from 
bronchopneumonia in this or any other volume. To a certain ex- 
tent the statement of "bronchopneumonia" itself is an unsatis- 
factory report of cause of death. While it is probably true that 
the disease is idiopathic in the majority of cases where it is the 
only cause reported, it is also true, and has been demonstrated, that 
in many cases the condition is a sequela of other diseases not men- 
tioned on the physician's original report. 



CHAPTER VII. 

Beight's Disease. 

Certification of Bright' s Disease. 

The statistical treatment of Brighf s disease mortality presents a 
number of difficulties. The condition, as will be described more 
fully later, often occurs in conjunction with the so-called cardio- 
vascular diseases, such as organic diseases of the heart, arterio- 
sclerosis, cerebral hemorrhage, etc. In such instances, much depends, 
in the statistical registration of the death, upon the definiteness with 
which the cause of death has been certified by the physician. 
Where, for example, the statement is " Bright's disease " combined 
with valvular disease of the heart, the death is assigned to the latter 
condition. A more specific statement of Bright's disease as chronic 
interstitial nephritis and valvular disease of the heart is, on the 
other hand, registered as a death from Bright's disease. The sev- 
eral terms used by physicians may refer to precisely the same dis- 
eases and conditions in each of the cases, but, in the one instance, 
the assignment of the death is to a heart condition, and in the 
other to the condition of the kidney. Standard practice requires such 
assignment; nevertheless, it is generally believed that, as a result 
of the present status of reporting, many cases of true Bright's dis- 
ease which would receive precedence if fully described, are lost 
from the record in view of the fact that few tables contain any ref- 
erence to the secondary causes of death. 

Mortality from Bright's Disease among Insured Wage Earners. 

Even under the above considerations, Bright's disease appears as 
the fourth cause in numerical importance in the Industrial expe- 
rience of the Metropolitan Life Insurance Company. In all, 52,067 
deaths were registered in the six-year period, corresponding to a 
rate of 96.8 per 100,000 living.* In general, the contour of the 

* These deaths include those certified as due to "Bright's disease," or 
"nephritis," without further qualification; also those reported as due to 
chronic Bright's disease, chronic nephritis, and to the several types of 

87 



88 



MORTALITY STATISTICS OF INSURED WAGE EARNERS. 



curve of mortality according to age is very similar to that for or- 
ganic heart disease, although the figures are in every case lower 
than those for the other condition. The mortality is comparatively 
low until the age period 20 to 24 years is reached. From this point 
onward, the increases are very marked, the rates (with one excep- 
tion) more than doubling from age period to age period until the 
maximum is reached in the most advanced age group, 75 years and 
over. 

The following table and graph present the detailed relations of 
the death rate from Bright's disease by color, sex and age classes: 

TABLE 38. 
Mortality from Bright's Disease, Classified by Color, Sex and by Age 

Period. 

Death Bates per 100,000 Persons Exposed. 1911 to 1916. 

Experience of Metropolitan Life Insurance Company. Industrial 

Department. 





Persons. 


WMte. 


Colored. 


Age Period. 


Males. 


Females. 


Males. 


Females. 


AU ages — one and 
over 


96.8 


97.1 


88.1 


138.7 


121.3 






lto4 

5 to 9 

10 to 14 

15 to 19 

20 to 24 

25 to 34 

35 to 44 

45 to 54 

55 to 64 

65 to 74 

75 and over. . 


5.7 

4.3 

4.9 

8.6 

15.3 

36.3 

101.3 

216.7 

453.3 

970.6 

1715.2 


5.8 

4.2 

3.8 

7.8 

14.8 

38.5 

119.3 

259.8 

539.3 

1146.3 

2106.7 


4.4 

4.2 

5.6 

8.8 

14.2 

31.8 

80.0 

171.5 

364.7 

826.0 

1466.6 


18.6 

4.9 

7.6 

9.9 

20.7 

41.5 

130.6 

301.9 

709.5 

1501.8 

2140.2 


9.5 

6.1 

5.9 

12.9 

22.2 

46.9 

127.8 

264.8 

501.3 

873.8 

1624.2 



Bright's disease is more commonly represented in the mortality 
experience of colored persons than among white persons. This is 
true for each of the sexes and for every age period. At some of the 
age periods, the excess among colored persons is very marked in- 
deed, although there is some irregularity as to the amount. 

There is also a sex distinction in Bright's disease mortality which 
merits some attention. Males show higher rates in all of the more 

Bright's Disease, for example, chronic interstitial nephritis, chronic paren- 
chymatous nephritis, chronic diffuse nephritis, etc. Deaths from acute 
nephritis are not included. 



BRIGHT S DISEASE. 



89 



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90 MORTALITY STATISTICS OF INSURED WAGE EARNERS. 

significant age periods. In those few age periods where females 
show higher rates, the incidence of the disease is not high and the 
facts are somewhat clouded by the possibility of incorrect certifica- 
tion. Thus, in the age period 15 to 19 years, where the death rate 
for females for both white and colored lives is significantly higher,, 
it is quite possible that this results from the inclusion of deaths 
from puerperal nephritis, which, if more complete statements had 
been made would not have been assigned to Bright's disease, but to 
the puerperal cause. 

Beginning with ages ten and over, the rate increases regularly 
with advancing age. The peculiar situation under ten, and espe- 
cially between one and four years, is probably explained by the 
inclusion of deaths from acute nephritis improperly certified as 
"Brighfs disease" or "nephritis." Many of these deaths should, 
properly, have been classified under one of the communicable dis- 
eases of childhood, which, in so many instances, are the primary 
factors in such deaths. 

Mortality from Brighfs Disease among White Insured Wage Earn- 
ers and among the General Population of the Expanding 
Registration Area Compared. 

As was the case in the discussion of organic heart disease, we 
find here a higher incidence of Bright's disease among insured 
white lives than in the general population. This is true for each 
period beyond age 20 years for both males and females. The com- 
parison is limited to the ages beyond 20 years because it is desired 
to eliminate the questionable data of the ages under 20 when, also, 
the rates are comparatively low. The excess is pronounced among 
males but by no means so marked among females. The maximum 
ratio of excess among white males occurs in the period 35 to 44 
years when the rate is 88.2 per cent, higher among the insured than 
in the general population. This ratio of excess decreases there- 
after, with a single exception. If it were possible to eliminate the 
small percentage of colored persons from the population of the 
Registration Area, the excess of the insurance experience would be 
even larger. Among females, the maximum difference in favor of 
the population occurs in the period 65 to 74 years (44.9 per cent.). 
These facts in the statistics for insured wage earners suggest that 
the more arduous pursuits of the industrial population may well be 



BRIGHT S DISEASE. 



91 



contributing factors in causing, or at least exciting, abnormal con- 
ditions of the kidney. Other factors, also, undoubtedly play their 
part; possibly the more general use of alcohol is important here, 
especially at the ages of middle adult life. 

The following table presents the death rates for the insured and 
the population of the expanding Eegistration Area, side by side, 
by sex and from ages 20 upward : 



TABLE 39. 

Mortality from Bright 's Disease. 

Death Bates per 100,000 Persons Exposed. Classified by Sex and hy Age 

Periods, 20 Yeairs and Over. Insured White Lives in Experience of 

Metropolitan Life Insurance Company, Indiistrial Department (1911 

to 1916) and General Population Experience of Expanding 

Eegistration Area of the United States (1910 to 1915). 





Males. 


Females. 


Age Period. 






Percentage 






Percentage 




M. L. I. Co. 


U. S. Reg. 


M. L. I. Co. 


M. L. I. Co. 


U. S. Reg. 


M. L. I. Co. 




(White). 


Area. 


of Reg. Area. 


(White). 


Area. 


of Reg. Area. 


All ages— 20 














and over 


198.1 


156.8 


126.3 


149.7 


131.4 


113.9 


20 to 24.... 


14.8 


11.0 


134.5 


14.2 


13.4 


106.0 


25 to 34.... 


38.5 


24.1 


159.8 


31.8 


27.0 


117.8 


35 to 44.... 


119.3 


63.4 


188.2 


80.0 


62.3 


128.4 


45 to 54.... 


259.8 


157.3 


165.2 


171.5 


131.7 


130.2 


55 to 64.... 


539.3 


368.4 


146.4 


364.7 


275.2 


132.5 


65 to 74.... 


1146.3 


773.1 


148.3 


826.0 


569.9 


144.9 


75 and over. 


2106.7 


1587.9 


132.7 


1466.6 


1129.5 


129.8 



Trend of the Death Rate from Bright's Disease. 

On the face of the figures there is a slight upward trend in the 
death rate from Bright's disease in this experience. The tendency 
is not alarming, in any sense, in view of the possibility that in more 
recent years physicians have been more definite in their state- 
ments of cause of death than at the beginning of the six-year period. 
The office practice of the Sta,tistical Bureau has also affected the 
figures, since a larger number of inquiries to physicians has been 
made in more recent years than at the beginning of the study, more 
particularly with reference to undesirable statements of "acute 
nephritis." There should, therefore, be no unrestrained interpre- 
tation of the figures shown below, especially in view of the diffi- 
culties pointed out at the beginning of this section on the still 



92 



MORTALITY STATISTICS OF INSURED WAGE EARNERS; 



unsettled condition of the cause of death classification procedure 
in cases where Bright's disease is associated with cardiovascular 
diseases. The figures are presented by color and sex for the indi- 
vidual years between 1911 and 1916 : 



TABLE 40. 

Mortality from Bright's Disease, Classified by Color and by Sex. 

Death Rates per 100,000 Persons Exposed. Single Years in Period 1911 

to 1916. 

Experience of Metropolitan Life Insurance Company. Industrial 

Department. 





Persons. 


White. 


Colored. 


Year. 


Males. 


Females. 


Males. 


Females. 


1911 to 1916 


96.8 


97.1 


88.1 


138.7 


121.3 


1916.... 
1915... 
1914... 
1913.... 
1912.... 
1911... 


99.0 
95.7 
95.4 
96.0 
99.4 
95.0 


99.0 
91.6 
94.7 
99.0 
101.5 
97.3 


90.3 

88.4 
86.7 
85.2 
90.4 
87.4 


138.9 
154.1 
142.7 
138.6 
132.9 
122.9 


130.8 
126.2 
121.7 
117.5 
120.7 
108.5 



The problem of increase in Bright's disease mortality, if there 
is one, is much more acute among colored lives than among white 
lives and if any significance attaches to the increasing mortality in 
more recent years, it applies entirely to the colored race. It is not 
possible at this time to explain satisfactorily what forces are at 
work behind the rapidly changing figures for the colored group. 



CHAPTEE VIII. 

ExTEENAL Causes of Death (Accident, Suicide and Homicide). 

The group of the external causes of death is the fifth in order of 
numerical importance in this investigation. 

In any discussion of mortality, we may, in general, distinguish 
two main classes; first, those diseases and conditions which arise 
from pathologic processes within the body, and second, conditions 
which follow injury by some means or agency external to the hu- 
man economy. Under each of these two fundamental divisions, we 
attempt to identify the specific agencies at work. Oftentimes, we 
must have recourse simply to a statement of the disease or condition 
present, without reference to the particular causative agency pro- 
ducing the disease. This observation applies especially to diseases 
of internal origin. The "external" conditions are by comparison 
less difficult to determine causally. Our first approach to them is 
to establish three classes, the division being made with respect to 
the element of human volition involved in the fact of injury. The 
first group consists of the accidental deaths, those accomplished by 
pure chance or through personal negligence without deliberate in- 
tent to kill, maim or incapacitate. The second group of external 
causes of death consists of the suicides, or cases where there was 
deliberate intent to accomplish self-destruction Under the third 
class, we consider all deaths (except war deaths) which arise from 
the impulse of one person to kill or injure another. These latter 
are "homicides." For each of these main classes of violence, we 
shall endeavor further to distinguish the means or agency of in- 
jury. War deaths have been taken from the class of accidental and 
unspecified violence and shown separately for purposes of this 
report. 

During the six-year period covered by this investigation of wage 
earners' mortality, there were 50,712 deaths from external violence 
of all kinds. The following table gives the incidence of the three 
chief groups of external causes represented in our records : 

93 



94 



MOKTALITY STATISTICS OF INSURED WAGE EARNERS. 



TABLE 41. 

Mortality from External Causes of Death. Classified According to 

•Main Groups. 

Deaths and Death Bates per 100,000 Persons Exposed and Per Cent, of 

Total Mortality from External Causes Represented in Each Main 

Group. 1911 to 1916. 

Experience of Metropolitan Life Insurance Company. Industrial 

Department. 



Class of External Violence. 


Number of 
Deaths. 


Per Cent, of 

Total External 

Causes. 


Death Rate 

per 100,000 

Exposed. 


Total external causes 


50,712 


100.0 


94.3 






Accidents, ind. unspec. violence* 
Suicides 


39,268 
6,542 
3,753 
1,149 


77.4 

12.9 

7.4 

2.3 


73.0 
12.2 


Homicides 


7.0 


War deaths 


2.1 



* Excludes ' ' war deaths. ' ' 

The total death rate corresponding to the 50,712 deaths was 94.3 
per 100,000, which, as we shall see later, is very considerably in 
excess of the rate for the external causes prevailing in the general 
population of the expanding Registration Area. More than three 
quarters of these deaths were due to accidents. If " war deaths " 
were included, as perhaps they should be to follow classification 
practice, the proportion would reach nearly 80 per cent. Suicides 
comprise 12.9 per cent, and homicides 7.4 per cent, additional. 
We shall consider in detail first the group of accidents. 



Accidents, Including Unspecified Violence. 

The general accident problem in the United States, and espe- 
cially as it affects the wage earner, should interest us because of 
the very considerable mortality which results from this group of 
causes. It would appear that the special conditions of American 
life and industry still give rise to hazards which result in an extra- 
ordinarily large fatal accident rate. When compared with acci- 
dent mortality in England and Wales, the American figures show 
up especially badly. In the year before the war, 1913, the fatal 
accident rate of England and Wales was, for males 35 to 44 years, 
62.4 per 100,000. In the Eegistration Area of the United States, 
the rate for males at these ages was 139.6 per 100,000, and, among 



EXTEENAL CAUSES OF DEATH. 95 

the insured white males, the rate was 154.3. In other words, the 
rate for England and Wales was 44.7 per cent, of that for the ex- 
panding Eegistration Area of the United States and only 40.4 per 
cent, of the rate for insured white males. Even when we consider 
the chief types of fatal accidents, such as falls, burns, drowning, 
and steam railroad accidents in these three series of figures, the 
rates of mortality as recorded for the United States are much above 
the figures for England and Wales, and those for the Industrial 
policyholders are, for the significant age periods, highest of all. 
The data on fatal accidents and especially the specific forms of ac- 
cidental injury which we have included for American wage earners 
should, therefore, constitute a very valuable contribution for the 
further study of the accident problem and should prove especially 
useful in the movement for increased industrial and public safety 
which has been developed during the last ten years. 

The 39,368 fatal accidents of all kinds, as we have seen, corre- 
sponded to a rate of 73.0 per 100,000 persons exposed. The fatal 
accident rate for males of both white and colored groups was more 
than three times the rate for females. The recorded fatal accident 
rate for colored males was somewhat higher than the rate for white 
males ; all ages one and over being combined for purposes of these 
comparisons. 

The accident death rate varies considerably with age; in fact, 
we may distinguish three divisional periods of age incidence. These 
are the period of early childhood, the period of occupational stress 
and finally the period of old age. Considering the group as a 
whole, we find that the highest accident death rate under age 45 
was recorded between the ages 1 and under 5 years. There is a 
decline in the rate from the figure under 5 years of age (93.7 per 
100,000) to the rate at the age group 10 to 14 years (41.4 per 
100,000). This latter rate is the minimum for any age period. 
Beginning with the age group 15 to 19 years there is a gradually 
rising rate up to the highest significant age period. For the white 
male and white female groups the minimum accident death rate is 
recorded, as for the total experience, between 10 and 14 years; but 
for colored males the minimum rate is reached between 5 and 9 
years and for colored females between 15 and 19 years. Only the 
white males exhibit a progressively increasing accident death rate 
with advancing age, beginning with the period 15 to 19 years. 
White females show a rather stationary tendency in the mortality 



96 



MOKTALITY STATISTICS OF INSUEED WAGE EAENEES. 



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EXTERNAL CAUSES OF DEATH. 



97 



rate between 15 and 35 years of age. Between 15 and 34 years 
colored males show a tendency toward decline; thereafter they ex- 
hibit a rising death rate. Colored females show a fluctuating fatal 
accident rate between 10 and 44 years and a rising rate thereafter. 
These facts are shown in the following table, and in Chart XI on 
page 96 : 

TABLE 42. 

Mortality from Accidental and Unspecified Violence,* Classified by 

Color, Sex and by Age Period. 

Death Rates per 100,000 Persons Exposed. 1911 to 1916. 

Experience of Metropolitan Life Insurance Company. Industrial 

Department. 





Persons. 


White. 


Colored. 


Age Period. 


Male. 


Female. 


Male. 


Female. 


All ages — one and 
over 


73.0 


115.9 


36.4 


121.4 


38.8 


1 to 4 

5 to 9 

10 to 14 

15 to 19 

20 to 24 

25 to 34 

35 to 44 

45 to 54 

55 to 64 

65 to 74 

75 and over . 


93.7 
51.4 
41.4 
53.4 
55.6 
57.9 
71.6 
95.2 
137.2 
251.4 


100.9 

68.9 

65.1 

85.7 

99.8 

114.5 

154.3 

195.1 

246.5 

346.0 


79.4 
31.9 
14.4 
16.9 
16.5 
15.7 
19.4 
35.5 
73.2 
201.1 
496.4 


151.3 
67.9 
83.5 
131.7 
109.4 
115.3 
124.8 
145.6 
180.7 
247.2 
315.5 


126.3 
51.2 
22.7 
18.2 
25.6 
22.5 
27.1 
41.1 
59.0 

167.9 


477.8 


482.4 


353.9 



* War deaths excluded. 



Color Ratio of Accident Mortality. 

The fatal accident rates of the white and colored races are, as 
we have seen, very different. We find, for example, that under 
5 years of age, colored children, both males and females, show a 
fatal accident rate about 1^ times that of white children. In the 
period 5 to 9 years colored males show a fatal accident rate just a 
little less than the white male rate. Between 15 and 19 years, how- 
ever, we observe the maximum percentage of excess of colored male 
over white male accident mortality. Colored females, on the other 
hand, show their maximum percentage of excess in accident mor- 
tality between 5 and 9 years of age. After the age period 25 to 34 
years, colored males show a lower mortality than white males, which 
condition is probably the result of their safer occupational condi- 



98 



MOETALITT STATISTICS OF INSURED WAGE EAENEES. 



tions. A similar condition of lower mortality prevails among the 
colored females after 45 to 54 years, but the cause for this is difi&- 
cult to ascertain. The following table affords a comparison of 
white and colored accident mortality according to sex : 

TABLE 43. 

Mortality from Accidental and Unspecified Violence.* 

Percentage, Colored of White Mortality at Specified Age Periods for Each 

Sex. 1911 to 1916. 
Metropolitan Life Insurance Company, Mortality Experience. Industrial 

Department. 





Percentage, Colored of Wbite Mortality. 


Age Period. 


Males. 


Females. 


All ages — one and over . . 


104.7 


106.6 


1 to 4 

5 to 9 ' 

10 to 14 

15 to 19 

20 to 24 

25 to 34 

35 to 44 

45 to 54 

55 to 64 

65 to 74 

75 and over 


150.0 

98.5 

128.3 

153.7 

109.6 

100.7 

80.9 

74.6 

73.3 

71.4 

65.4 


159.1 

160.5 

157.6 

107.7 

155.2 

143.3 

139.7 

115.8 

80.6 

83.5 

71.3 



* War deaths excluded. 



Sex Ratio of Accident Mortality. 

The differences in the stresses of occupation between the sexes 
are clearly reflected in the accident death rates. Considering white 
lives first, there was an excess of the male accident rate over the 
female rate in every age period of our data, with the exception of 
the last age group, 75 years and over. The maximum percentage of 
excess of male accident mortality is found between 35 and 44 years 
of age, when the male rate is nearly eight times greater. Among 
white lives between 1 and 45 years of age there is increasing per- 
centage of excess of male over female accident mortality ; after 45, 
the excess becomes regularly less. Colored persons did not show 
any such increase with age in the excess percentage of male over 
female mortality. The maximum percentage of excess of males 
over females among colored persons is found between the ages 15 
and 19 years, where colored males show a fatal accident rate nearly 



EXTERNAL CAUSES OF DEATPI. 



99 



71 times that of colored females. These facts are exhibited in the 
following table : 

TABLE 44. 

Mortality feom Accidentai, and UNSPECiFna) Violence.* 

Percentage, Male of Female Mortality at Specified Age Periods for Each 

Color Class. 1911 to 1916. 

Experience of Metropolitan Life Insurance Company. Industrial 

Department. 





Percentage, Male of Female Mortality. 


Age Period 


Wliite. 


Colored. 


All ages — one and over . . 


318.4 


312.9 


1 to 4 


127.1 
216.0 
452.1 
507.1 
604.8 
729.3 
795.4 
549.6 
336.7 
172.1 
97.2 


119 8 


5 to 9 


132 6 


10 to 14 

15 to 19 

20 to 24 

25 to 34 

35 to 44 

45 to 64 

55 to 64 

65 to 74 

75 and over 


367.8 
723.6 
427.3 
512.4 
460.5 
354.3 
306.3 
147.2 
89.1 



* War deaths excluded. 



Fatal Accident Rate among Insured Wage Earners and Population 
of the Expanding Registration Area Compa/red. 

Before proceeding to a detailed consideration of the various 
forms of accidents represented in our experience, it might Be well, 
in passing, to exhibit a table of the accident death rates per 100,000 
among white insured wage earners and in the general population 
of the expanding Registration Area of the United States. The 
table on page 100 affords a view of these data. 

Under 20 years and after 35 years of age white males of the in- 
sured wage earners' group show a higher accident mortality than 
do males in the Registration Area in general. For the ages under 
5 years, insured white males show an accident death rate 5 per cent, 
in excess, between 5 and 9 years, 17 per cent., and between 10 and 
14, 14 per cent, in excess of the rates among males in the corre- 
sponding age groups of the general population. Between 20 and 
34 years of age insured white male wage earners show a lower mor- 
tality from accidents than was recorded among males in the Regis- 
tration Area record. Beginning with the age period 35 to 44' 



100 



MORTALITY STATISTICS OF INSURED WAGE EARNERS. 



TABLE 45. 

Mortality from Acicidental and Unspecified Violence.* 
Death Mates per 100,000 FersonS Exposed. Classified hy Sex and by Age 
Period. Insured White Lives in Experience of Metropolitan Life In- 
surance Company, Industrial Department (1911 to 1916) and 
General Population Experience of Expanding Begistra- 
tion Area of the United States (1910 to 1915). 





Males. 


Females. 


Age Period. 






Percentage 






Percentage 




M. L. I. Co. 


U. S. Reg. 


M. L. I. Co. 


M. L. I. Co. 


U. S. Reg. 


M. L. I. Co. 




(White). 


Area. 


of Reg. Area. 


(White). 


Area. 


of Reg. Area. 


All ages — one 














and over . . . . 


115.9 


120.8 


95.9 


36.4 


37.4 


97.3 


lto4..... 


100.9 


96.4 


104.7 


79.4 


76.5 


103.8 


5 to 9 


68.9 


58.8 


117.2 


31.9 


29.6 


107.8 


10 to 14.... 


65.1 


56.9 


114.4 


14.4 


13.0 


110.8 


15 to 19.... 


85.7 


85.0 


100.8 


16.9 


15.4 


109.7 


20 to 24.... 


99.8 


116.6 


85.6 


16.5 


17.0 


97.1 


25 to 34.... 


114.5 


123.4 


92.8 


15.7 


15.5 


101.3 


35 to 44... 


154.3 


139.6 


110.5 


19.4 


18.9 


102.6 


45 to 54... 


195.1 


156.8 


124.4 


35.5 


27.7 


128.2 


55 to 64... 


246.5 


178.5 


138.1 


73.2 


49.0 


149.4 


65 to 74... 


346.0 


214.3 


161.5 


201.1 


118.1 


170.3 


75 and over 


482.4 


418.0 


115.4 


496.4 


534.8 


92.8 



* War deaths excluded. 



years, however, accident mortality among white male insured wage 
earners begins progressively to exceed the rates among males in the 
general population up to and including the period 65 to 74 years. 
The figures for ages beyond 75 years are not significant in view 
of the small exposure. 

The comparisons between insured white females and females in 
the general population also show higher death rates for the insured 
group, with the exception of the age period 20 to 24 years, than for 
the group of females in the general population. The differences 
are not so marked, however, as they were for the males. Below 20 
years of age the percentages of excess of accident mortality among 
insured white females are variable. Beginning with the age period 
25 to 34 years there is a progressive increase in the excess of acci- 
dent fatality rates among white female wage earners over the rates 
for females in the general population. 

Fatal Accidents According to Specific Means or Nature of Injury. 

The foregoing observations on accident mortality were made 

without reference to the specific nature or means of injury. We 



EXTERNAL CAUSES OF DEATH. 



101 



shall now consider briefly the several inclusions under the general 
title as shown in the followinar table : 



TABLE 46. 

Mortality from Accidental and Unspecified Violence.* 

Deaths and Death Bates per 100,000 Persons Exposed hy Specified Ca/uses 

and hy Color and Sex. 1911 to 1916. 

Experience of Metropolitan Life Insurance Company. Industrial 

Department. 



Cause of Death. 



Persona. 




Rate per 100,000. 








White. 


Colored. 




Rate 
per 










Deaths. 












100.000. 


Males. 


males. 


Males. 


Fe- 
males. 


39268 


73.0 


115.9 


36.4 


121.4 


38.8 


622 


1.2 


1.2 


1.0 


1.5 


1.8 


1144 


2.1 


2.4 


1.8 


2.7 


2.0 


576 


1.1 


1.2 


.7 


2.0 


2.0 


4714 


8.8 


7.2 


9.3 


8.4 


14.3 


1431 


2.7 


3.9 


1.9 


2.3 


.9 


5757 


10.7 


20.1 


2.6 


23.2 


2.1 


1029 


1.9 


3.0 


.3 


8.1 


1.5 


93 


.2 


.2 


.1 


.7 


.2 


6917 


12.9 


18.8 


8.9 


13.3 


5.3 


660 


1.2 


2.5 


t 


3.6 





612 


1.1 


2.4 


t 


3.4 


— 


48 


.1 


.2 


t 


.2 


— 


905 


1.7 


3.4 


.1 


4.8 


.1 


4485 


8.3 


16.8 


1.2 


17.3 


1.6 


1600 


3.0 


5.3 


1.2 


4.1 


.9 


2507 


4.7 


8.1 


2.3 


4.6 


1.3 


1658 


3.1 


5.7 


.9 


5.6 


.5 


381 


.7 


1.4 


.1 


1.9 


.1 


233 


.4 


.9 


t 


1.1 


— 


16 


t 


t 


t 


.1 


t 


217 


.4 


.6 


.1 


1.5 


.5 


1247 


2.3 


3.4 


1.3 


4.3 


1.6 


96 


.2 


.3 


t 


.5 


— 


452 


.8 


2.0 


t 


.7 


.1 


806 


1.5 


1.9 


1.2 


1.9 


.5 


1722 


3.2 


5.4 


1.2 


7.5 


1.4 



Accidents and Unspecified 

Violence — Total* 

Poisoning by food 

Other acute poisonings 

Conflagration 

Burns — conflagration excepted . . . 
Absorption of deleterious gases 

— conflagration excepted .... 

Accidental drowning 

Traumatism by firearms 

Traumatism by cutting or 

piercing instruments 

Traumatism by fall 

Traumatism in mines and 

quarries (total) 

— in mines 

— in quarries 

Traumatism by machines 

Steam railroad accidents and 

injuries 

Street car accidents and injuries. . 
Automobile accidents and injuries 

Injuries by other vehicles 

Landslide, other cnishing 

Injuries by animals 

Starvation 

Excessive cold 

Effects of heat 

Lightning 

Electricity — lightning excepted . . . 
Fractures — cause not specified . . . 
Other external violence* 

* War deaths excluded. 

t Less than .05 per 100,000. 



Thus, among all accidents included in the above table, falls 
were the most frequent of the specified forms of violence. There 



102 



MOETALITT STATISTICS OF INSUEED WAGE EAENEES. 



were 6,917 deaths from falling recorded among insured wage earn- 
ers over the six-year period 1911 to 1916, at a rate of 12.9 per 
100,000 exposed. Accidental drowning was next in importance 
with 5,757 deaths at a rate of 10.7 per 100,000 in the six-year 
period under observation. Burns, excluding burns in conflagra- 
tions, followed with 4,714 deaths, or at a rate of 8.8 per 100,000 
exposed. Steam railroad accidents and injuries showed 4,485 
deaths, producing a rate of 8.3 per 100,000. Automobile accidents 
and injuries were recorded in 2,507 cases, with a death rate of 4.7 
per 100,000 exposed. A detailed discussion of the facts for some 
of the more important of these modes of injury in external causes 
of death follows. 

Teaumatism by Pall.* 

We have previously indicated that traumatism by fall was the 
chief form of the fatal accidents. The 6,917 deaths from this con- 
dition corresponded to a rate of 12.9 per 100,000 exposed. The 



TABLE 47. 

MORTAT.TTY FROM TRAITMATISM BY FALL,* CLASSIFIED BY COLOR, SeX AiiT) BY 

Age Period. 

Death Bates per 100,000 Persons Exposed. 1911 to 1916. 

Experience of Metropolitan Life Insurance Company. Industrial 

Department. 





Persons. 


White. 


Colored. 


Age Period. 


Males. 


Females. 


Males. Females. 


All ages — one and 
over 


12.9 


18.8 


8.9 


13.3 5.3 






1 to 4 

5 to 9 

10 to 14 

15 to 19 

20 to 24 

25 to 34 

35 to 44 

45 to 54 

55 to 64 

65 to 74 

75 and over. . 


10.1 

4.3 

3.1 

3.4 

4.4 

7.2 

13.3 

20.9 

39.3 

103.8 

243.9 


11.7 

6.1 

4.8 

5.9 

8.8 

15.5 

31.3 

42.6 

64.0 

116.5 

208.5 


7.7 

2.4 

1.1 

1.0 

.9 

1.9 

3.5 

9.7 

27.2 

105.4 

288.0 


19.9 

7.5 

5.1 

5.4 

5.6 

8.8 

16.2 

22.1 

37.2 

51.8 

68.6 


9.5 

1.9 

2.5 

1.8 

2.4 

2.3 

2.6 

5.8 

14.1 

57.5 

108.9 



* Falls from steam railroad trains, street cars, automobiles and other 
vehicles, as well as falls in mines or quarries, from machinery (travelling 
cranes, for example), and falls in burning buildings are classified under 
other headings. In short, not aU falls are classified under ' ' Traumatism by 
fall." 



EXTERNAL CAUSES OF DEATH. 103 

rate was highest for white males and least for colored females. 
Males of both the white and colored groups showed a higher rate 
for this cause of death than did females. The facts by age are 
given on page 103. 

The death rate from traumatism by fall showed a high point for 
the ages 1 to 4 years in our experience. The rate for all persons 
was 10.1 per 100,000 exposed in this age group. This rate is not 
exceeded in any age period thereafter until the period 35 to 44 
years is reached, when it begins to rise sharply. For this age 
period a rate of 13.3 per 100,000 exposed is recorded. After a series 
of increments the maximum rate for any age period is reached at 
the group of ages 75 years and over (243.9 per 100,000 exposed). 

The fatal accident rate for this specific cause exhibits the same 
age characteristics for white males as we have pointed out for the 
entire experience with this exception : the rate for the age group 
1 to 4 years is exceeded by that for 25 to 34 years instead of by that 
for 35 to 44 years. For white females, however, there seems to be a 
practically stationary death rate from this cause between 10 and 
24 years. For the ages thereafter, a rapid increase in the rate is 
observed. For the highest age group in our series (75 years and 
over) the white female fatal accident rate for this specific cause 
exceeds the white male rate considerably. Colored males, with 
advancing age, show a gradually increasing death rate from this 
cause, beginning with the period 10 to 14 years. Colored females 
between 20 and 44 years show a fairly stationary rate from trau- 
matism by fall. 

The figures for the individual years from 1911 to 1916 do not 
show very marked differences. The highest rate was observed in 
1913, 13.7 per 100,000, and the minimum in 1915, 11.9. Unlike 
the acute infections and the organic diseases, we may hardly expect 
a definite trend over a short period of years. The average rate of 
the six-year period, 12.9 per 100,000, may be taken as a fair indi- 
cation of the present incidence of this cause of death. Nor is there 
any very marked difference in incidence of this condition among 
the insured and the general population, all ages considered. When 
we analyze the facts by age period, we find that up to age 25 the 
rates are very much the same. Beyond that period the figures are 
higher for the insured group. This is especially so among the 
males where the occupational factor is important as a fruitful 



104 



MORTALITY STATISTICS OP INSURED WAGE EARNERS. 



source of mortality among wage earners. Thus, at some age peri- 
ods of advanced life, such as 55 to 64 years, the rate is very much 
higher among insured white males than among males in the Eegis- 
tration Area, the rates being 64.0 and 38.1 per 100,000, respectively. 

Accidental Drowning.* 

The 5,757 deaths from drowning during the period 1911 to 1916 
correspond to a rate of 10.7 per 100,000 exposed. As might be 
expected, the rate shows a very marked difference for the two sexes. 
The rate for white males is a little less than eight times the rate 
for white females. Colored males show a rate from this cause 
more than ten times the rate for colored females. 

Deaths from Accidental Drowning hy Color, Sex and by Age 

Period. 

The death rates per 100,000 for accidental drowning, according 
to color, age and sex classes are presented in the following table : 



TABLE 48. 

Mortality from AcciDENTAii Drowning,* Classified by Color, Sex and 

BY Age Period. 

Death Bates per 100,000 Persons Exposed. 1911 to 1916. 

Experience of Metropolitan Life Insurance Company. Industrial 
Department. 





Persons. 


White. 


Colored. 


Age Period. 


Males. 


Females. 


Males. 


Females. 


AH ages — one and 
over 


10.7 


20.1 


2.6 


23.2 


2.1 






1 to 4 

5 to 9 

10 to 14 

15 to 19 

20 to 24 

25 to 34 

35 to 44 

45 to 54 

55 to 64... . 
65 to 74 ... . 
75 and over. . 


6.2 

10.2 

13.9 

17.0 

12.7 

9.0 

8.0 

9.3 

8.7 

9.1 

9.1 


9.1 

18.6 
23.8 
27.4 
22.0 
17.8 
18.7 
21.5 
21.3 
21.9 
22.7 


3.6 
2.3 
2.7 
4.7 
4.4 
1.7 
1.2 
1.9 
1.3 
1.6 
2.5 


5.8 
10.7 
34.8 
50.2 
30.2 
25.2 
15.6 
16.3 
10.2 
11.7 


1.9 
1.6 
2.8 
2.6 
2.6 
1.5 
2.1 
2.9 
2.2 
1.2 



* Under this heading are classified, first, the deaths from drowning that 
are known to be accidental and, second, those which are not definitely re- 
ported as accidental but which can not be identified as suicidal or homicidal. 



EXTERNAL CAUSES OF DEATH. 105 

The death rates for accidental drowning are highest for per- 
sons under age 25 years. Considering all persons in this experience 
combined, the maximum rate is reached in the age period 15 to 
19 years, 17.0 per 100,000 exposed. After this period, there is a 
decline in the rate from this cause up to and including the period 
35 to 44 years. After that period we show a slightly variable death 
rate, tending to vary somewhat around an average of 9.0 per 100,000 
exposed at these ages. 

White males show a maximum rate in the period 15 to 19 yeara 
and a declining rate thereafter up to and including 35 to 34 years. 
Between 45 and 74 years, the rate is almost stationary at a little 
more than 21 per 100,000 exposed. 

The colored male statistics also show a maximum rate between 
15 and 19 years of age, 50.2 per 100,000 exposed. The reader will 
observe that this rate is practically twice the rate recorded for white 
males between these ages. The colored male rate is higher than 
the white male rate from 10 years up to and including the age 
period 25 to 34 years, but is lower thereafter. 

Considering the series of years 1911 to 1916, we are again unable 
to detect any distinct downward tendency in the death rate from 
this cause. The rates seem to vary but slightly from a figure of a 
little more than 10 per 100,000 exposed for all classes in the expe- 
rience. The highest death rate was recorded in 1913, 12.1 per 
100,000, and the lowest in 1916, 9.7 per 100,000. During this 
period the death rate from this cause showed two points of maxi- 
mum incidence, in 1913 and in 1915. The high rate for 1913 is 
perhaps explained by the floods in the Ohio Eiver Yalley in the 
spring of that year. The figures for 1915 result from the inclusion 
of the deaths reported in connection with the Eastland disaster in 
Chicago. There were, in fact, 171 deaths of policyholders reported 
as arising out of this catastrophe. 

The death rate from drowning among white male policyholders was 
higher at every age period with the exception of the years under five 
than among males in the general population. The reader will ob- 
serve that a comparison of the death rates for this accidental cause in 
the two experiences is first conditioned by the differences in the areas 
covered by the two experiences. It is evident that for a population 
situated near water courses, where there is opportunity for employ- 
ment in the pursuits connected with navigation, one may expect a 



106 



MOETALITY STATISTICS OF INSURED WAGE EARNERS. 



higher death rate for accidental drowning. We are not able to say 
whether the differences in the hazards of accidental drowning are 
greater in the localities covered by this Company than in those 
areas comprising the total Eegistration Area of the United States. 

Burns (Conflagration Excepted).* 

The 4,714 deaths from burns in this mortality experience of in- 
sured wage earners during the six-year period 1911 to 1916 repre- 
sented a rate of 8.8 per 100,000 exposed. 

The rate for this cause among white males was lower than among 
the other three color and sex classes of this experience. The col- 
ored death rates for males and females were higher than the white 
death rates in the corresponding sex classes. Colored females 
showed a rate for burns practically one and one-half times that of 
white females. 

The death rates according to color, sex and age distinctions are 
set forth in the following table : 

TABLE 49. 

moktality from bubns (conflagration excepted),* classified by color, 

Sex and by Age Period. 

Death Bates per 100,000 Persons Exposed. 1911 to 1916. 

Experience of Metropolitan Life Insurance Company. Industrial 

Department. 





Persons. 


WTilte. 


Colored. 


Age Period. 


Males. 


Females. 


Males. 


Females. 


AH ages — one and 
over 


8.8 


7.2 


9.3 


8.4 


14.3 


1 to 4 

5 to 9 

10 to 14 

15 to 19 

20 to 24 

25 to 34 

35 to 44 

45 to 54 ... . 

55 to 64 

65 to 74 

75 and over. . 


43.8 

10.4 

2.6 

2.1 

3.0 

3.2 

4.3 

6.7 

10.0 

20.3 

41.8 


42.8 
6.7 
1.2 
1.1 
1.7 
1.9 
3.2 
4.6 
5.8 
8.8 

17.0 


40.0 

12.5 

3.7 

2.7 

3.3 

3.7 

4.6 

7.5 

11.4 

23.4 

49.4 


74.3 
9.4 
2.5 
2.6 
3.0 
3.3 
4.6 
3.9 
7.8 
23.4 
41.2 


76.8 

30.1 

7.1 

5.9 

7.7 

5.0 

6.0 

12.8 

20.7 

55.2 

118.0 



* Burns and scalds due to railroad, machinery, and mining accidents, 
as well as those caused by electricity and lightning are not classified under 
this heading. This explains, to some extent, the comparatively low rate for 
males. 



EXTEENAL CAUSES OF DEATH. 107 

The age characteristics of this cause of death present a maximum 
rate in the entire experience at the ages under 5 years, a decline to 
a minimum between the ages 15 to 19 years and a gradual rise in 
the rate for succeeding age periods to a figure approaching the 
maximum at ages 75 years and over. The conformation of the 
mortality curve for hums is in general the same for each of the 
color and sex classes of this experience, although, as we have pointed 
out, the actual figures show considerable differences. 

From the figures at hand no upward or downward tendency of 
the death rate for burns is evident. 

The incidence of fatal burns is higher among the insured than 
in the general population at a number of age periods. Thus, 
among insured white males, there is an excess in the ages under 
10. and after 45. The figures for all ages combined are in favor 
of the general population, 6.2 per 100,000 as compared with 7.2 
for insured white males. Comparison of the mortality facts for 
burns among insured white females and among females in the 
general population shows no important differences in the experi- 
ence of the two groups. 

Steam Raileoad Accidents and Injueies. 

Fatalities arising out of railroad accidents are an important ele- 
ment in mortality experiences generally. Among the wage earners 
represented in this study we recorded during the period 1911 to 
1916, 4,485 deaths arising from railroad accidents and injuries. 
These deaths corresponded to a rate of 8.3 per 100,000 exposed. 
For colored males we recorded a higher rate, 17.3 per 100,000, than 
for white males, 16.8 per 100,000. The colored female rate is 
higher than the corresponding white rate, but that for each group 
of females is low. 

The death rate from this cause shows a minimum at the ages 
under 5 years and a maximum at the highest age group in 
this discussion. There is a fairly progressive rise in the rate 
by age period throughout life. Between 20 and 54 years of age, 
however, there is no upward tendency. After the latter age period 
the rate rises quite sharply. The same general age charateristics 
in the mortality rate from this cause are shown for white males 
as for the general experience. White females show no important 



108 



MORTALITY STATISTICS OF INSURED WAGE EARNERS. 



mortality from this cause at the ages under 45 years. Beyond 
that age, however, a rising rate is in evidence for this group. 

The table below exhibits the data for steam railroad accidents 
and injuries according to the several color, sex and age classes : 

TABLE 50. 

Mortality from Steam Eailroad Accidents and Injuries, Classified 

BY Color, Sex and by Age Period. 

Death Bates per 100,000 Persons Exposed. 1911 to 1916. 

Experience of Metropolitan Life Insurance Company. Industrial 
Department. 





Persons. 


White. 


Colored. 


Age Period. 


Males. 


Females. 


Males. 


Females. 


All ages — one and 
over 


8.3 


16.8 


1.2 


17.3 


1.6 






1 to 4 

5 to 9 

10 to 14 

15 to 19 

20 to 24 

25 to 34 

35 to 44 

45 to 54 

55 to 64 

65 to 74 

75 and over. . 


1.1 

2.3 

3.5 

8.4 

11.8 

11.3 

10.7 

11.3 

15.6 

17.3 

17.8 


1.5 
3.9 
6.1 
15.2 
25.1 
26.6 
26.7 
27.1 
35.3 
39.4 
34.0 


.7 

.8 

.7 

1.2 

.7 

.7 

.7 

1.7 

3.6 

4.1 

5.9 


.6 
3.6 
7.0 
19.8 
25.0 
20.7 
19.8 
21.5 
27.6 
23.4 
41.2 


.3 
.6 
1.5 
1.1 
1.6 
2.4 
1.8 
2.2 
4.7 
27.2 



Colored males show a rather variable rate with age. There is a 
rising incidence for the ages under 35 years. Between 25 and 
74 years the rate tends to vary somewhat between SO and 28 per 
100,000 exposed. Beyond the latter age period our figures are not 
of much significance. The rates by age for colored females are too 
small and too variable to warrant extended discussion. 

Considering the period as a whole, there appears to be a decrease 
in the rate, especially among white males. The three years, 1914 
to 1916, however, show a slight upward tendency. 

In the following table we present our data for railroad accidents 
and injuries for single years from 1911 to 1916 : 



EXTERNAL CAUSES OF DEATH. 



109 



TABLE 51. 

Mortality from Steam Eailroad Accidents and Injuries, Classified by 

Color and by Ses:. 
Death Bates per 100,000 Persons Exposed. Single Years in Period 1911 

to 1916. 

Experience of Metropolitan Life Insurance Company. Industrial 

Department. 





Personis. 


White. 


Colored. 


Year, 














Males. 


Females. 


Males. 


Females. 


1911 to 1916 


8.3 


16.8 


1.2 


17.3 


1.6 


1916.... 


7.9 


15.3 


1.3 


18.5 


1.8 


1915.... 


7.4 


15.0 


1.0 


16.0 


1.1 


1914.... 


7.5 


15.1 


1.0 


16.0 


1.3 


1913.... 


9.0 


18.8 


1.1 


16.9 


1.2 


1912.... 


9.2 


18.5 


1.4 


17.6 


2.2 


1911.... 


9.5 


19.2 


1.3 


18.6 


2.2 



Automobile Accidents and Injuries. 

Automobile accidents and injuries are beginning to constitute an 
important cause of accident fatality. In the six years under dis- 
cussion we registered 2,507 deaths from this cause. The death rate 

TABLE 52. 

Mortality from Automobile Accidents and Injuries, Classified by 
Color, Sex and by Age Period. 

Death Bates per 100,000 Persons Exposed. 1911 to 1916. 

Experience of Metropolitan Life Insurance Company. Industrial 
Department. 





Persons. 


White. 


Colored. 


Age Period. 


Males. 


Females. 


Males. 1 Fema!es. 


All ages — one and 
over 


4.7 


8.1 


2.3 


4.6 


1.3 






1 to 4 

5 to 9 

10 to 14 

15 to 19 

20 to 24 

25 to 34 

35 to 44 

45 to 54 

55 to 64 

65 to 74 

75 and over. . 


3.7 
8.6 
5.1 
2.9 
3.2 
3.0 
3.2 
4.4 
7.3 
9.5 
10.1 


4.5 

12.5 

8.5 

4.9 

5.9 

6.4 

6.6 

9.1 

14.1 

18.6 

17.0 


2.9 
4.9 
1.8 
1.2 
1.5 
1.0 
1.6 
2.0 
3.6 
4.5 
6.7 


3.8 
10.4 
6.3 
3.5 
2.0 
2.9 
3.6 
3.3 
7.8 
6.7 
13.7 


1.3 

3.2 

1.6 

.3 

.8 

.9 

.3 

1.8 

2.2 

4.7 



110 



MORTALITY STATISTICS OF INSURED WAGE EARNERS. 



was 4.7 per 100,000 exposed. The highest death rate was shown 
for white males and the least for colored females. The color, sex 
and age statistics for automobile accidents and injuries are shown 
on previous page (Table 52). 

There is a high point of mortality from automobile accidents and 
injuries at each end of the age curve. There is one very high 
rate in childhood between 5 and 9 years and another in old age at 
the period 75 years and over, although the ages beginning with 55 
years are all heavily weighted with automobile deaths. Males of 
both color groups in this experience show a higher death rate than 
do females. 

According to our records there is a progressively increasing death 
rate year by year from this cause. In 1911 we recorded a rate of 
3.3 per 100,000 exposed. In 1916 the rate had increased to 7.4 
per 100,000. This corresponds to an increase of 221.7 per cent, in 
the rate. The following table and Chart XII on page 111 show the 
general trend of the death rate for automobile fatalities : 



TABLE 53. 
Mortality from Automobile Accidents and iNJURrES, Classified by 

Color and by Sex. 
Death Bates per 100,000 Persons Exposed. Single Years in Period 1911 

to 1916. 

Experience of Metropolitan Life Insurance Company. Industrial 

Department. 





Persona. 


White. 


Colored. 


Year. 














Males. 


Females. 


Males. 


Females. 


1911 to 1916 


4.7 


8.1 


2.3 


4.6 


1.3 


1916.... 


7.4 


12.9 


3.4 


8.2 


2.5 


1915. . 


5.4 


9.4 


2.6 


5.7 


1.3 


1914 ... 


4.8 


8.5 


2.4 


4.2 


.8 


1913... 


4.1 


7.5 


1.9 


3.8 


1.2 


1912.... 


3.0 


4.8 


1.8 


2.9 


.7 


1911.... 


2.3 


4.0 


1.1 


1.9 


1.1 



Available population mortality data show a similarly increasing 
rate for automobile fatalities. This fact calls for further inquiry 
into the causes contributing to this category of traffic accidents, 
especially in cities where the growth of population and the volume 
of street traffic conduce to an increase in liability to automobile 
accidents. 



EXTERNAL CAUSES OF DEATH. 



Ill 



Chart Xil. — Mortality from Automobile Accidents and Injuries 

.Death Rata* perlOO.OOOParaona Expoaed By Singia Yaara 1911 to 1916 
Cxparlanoa of Metropolitan Life Insurance Company, Industrial Department 
Death Rate 
par 100,000 

I* 




ign 



tgtz /g/J 



/p/4 /p/S JQl6 



112 



MORTALITY STATISTICS OF INSUEED WAGE EAENERS. 



Steeet Cae Accidents and Injueies. 

Fatalities registered as street car accidents and injuries in this 
experience included deaths, not only of persons riding on or oper- 
ating street cars, but also those deaths on elevated and subway 
trains and on tracks and rights of way of street railways, inter- 
urban roads operated electrically, subways and elevated railroads. 
There were registered 1,600 deaths from this cause, the correspond- 
ing rate being 3.0 per 100,000 exposed in the six years under obser- 
vation. The rate is highest among white males and least among 
colored females. 

There is a fairly high rate for the ages under 5 years and a declin- 
ing one thereafter through the age period 20 to 24 years. After that 
age group, however, the rate increases up to the maximum at the 
highest age group in our series. The same general observations 
apply to the experience of white males and white females. For the 
former, however, the age groups 5 to 9 years and 20 to 24 years 
show increases over those immediately preceding, while for the 
latter the decline continues through the period 25 to 34 years. The 
data for colored lives according to age group are based upon a small 



TABLE 54. 

Mortality from Street Car Accidents and Injuries, CLASsmED by 
Color, Sex and by Age Period. 

Death Bates per 100,000 Persons Exposed. 1911 to 1916. 

Experience of Metropolitan Life Insurance Company. Industrial 
Department. 





Persons. 


White. 


Colored. 


Age Period. 


Males. 


Females. 


Males. 


Females. 


All ages — one and 
over 


3.0 


5.3 


1.2 


4.1 


9 






1 to 4 

5 to 9 

10 to 14 

15 to 19 

20 to 24 

25 to 34 

35 to 44 

45 to 54 

55 to 64 

65 to 74 

75 and over. . 


2.7 
2.6 
1.6 
1.6 
1.4 
2.1 
3.1 
4.9 
7.8 
10.3 
22.1 


3.0 

3.6 

2.6 

2.4 

2.7 

4.9 

7.5 

11.1 

15.3 

20.6 

41.1 


2.5 

1.6 

.6 

.5 

.4 

.2 

.5 

1.4 

3.8 

4.4 

12.6 


1.9 
3.2 
1.9 
4.5 
2.0 
3.4 
4.6 
5.2 
9.0 
13.3 
27.4 


1.9 

1.3 

.9 

.6 

.3 

.2 

.8 

2.4 

1.3 

2.3 



EXTERNAL CAUSES OF DEATH. 



113 



number of deaths under 20 years of age and there is, therefore, 
some irregularity in the rates for the divisional periods of life. 
From twenty years of age upward among colored males an increas- 
ing death rate from this cause is found. 

The table on page 112 gives the rates for street car accidents, 
and injuries by color, sex and by age period. 

For the six years under discussion a generally declining death 
rate from this cause is observed. This is in contradistinction to 
the observed facts for automobile accidents and injuries. The fol- 
lowing table gives a view of the trend of this phase of the mortality 
experience for the period 1911 to 1916: 



TABLE 55. 

MOKTALITT FROM STREET Car ACCIDENTS AND INJUEIES, OlASSIPIED BY 

Color and by Sex. 
Death Bates per 100,000 Persons Exposed. Single Years in Period 1911 

to 1916. 

Experience of Metropolitan Life Insurance Company. Industrial 

Department. 







^^^llte. 


Colored. 


Year. 


Persons. 


Males. 


Females. 


Males. 


Females. 


1911 to 1916 


3.0 


5.3 


1.2 


4.1 


.9 


1916.... 


2.6 


4.4 


1.2 


3.5 


.9 


1915.... 


2.2 


3.9 


.9 


2.1 


.9 


1914.... 


2.7 


4.5 


1.1 


4.2 


1.4 


1913.... 


3.6 


6.4 


1.4 


4.6 


1.2 


1912.... 


3.5 


6.4 


1.4 


4.6 


.5 


1911.... 


3.6 


6.7 


1.3 


5.8 


.5 



Injuries by Other Vehicles. 

The record of deaths from injuries by "other vehicles" is also 
available. Under this group, 1,658 deaths were included arising 
from accidents and injuries to passengers, pedestrians, drivers or 
riders on wagons, carriages, bicycles and other miscellaneous forms 
of vehicles not motor driven. The rate, 3.1 per 100,000 exposed, 
is similar to that for street car accidents and injuries. 

The following table gives the rates per 100,000 by color, sex and 
age period: 



lU 



MOKTALITT STATISTICS OF INSURED WAGE EAENBRS. 



TABLE 56. 

Mortality from Injuries by Other Vehicles, Classified by Color, Sex 
AND BY Age PiaiiOD. 

Beaili Bates per 100,000 Persons Exposed. 1911 to 1916. 

Experience of Metropolitan Life Insurance Company. Industrial 
Department. 





Persons. 


White. 




Age Period. 






Colored Males. 






Males. 


Females. 




All ages — one and over. 


3.1 


5.7 


.9 


5.6 


lto4 


3.8 


4.6 


3.2 


2.6 


5 to 9 


3.8 


6.0 


1.5 


5.5 


10 to 14 


1.6 


2.8 


.5 


2.8 


15 to 19 


1.8 


3.0 


.5 


4.5 


20 to 24 


2.0 


4.0 


.5 


2.6 


25 to 34 


2.4 


5.6 


.3 


3.9 


35 to 44 


3.2 


7.7 


.3 


6.0 


45 to 54 


4.6 


10.1 


1.0 


10.7 


55 to 64 


5.0 


11.4 


.9 


12.0 


65 to 74 


8.2 


16.1 


3.1 


16.7 


75 and over .... 


5.3 


12.8 


.8 


13.7 



There seems to be a slight downward tendency in this group of 
specific causes of accidental injury. The following table gives a 
survey of the death rates over the period 1911 to 1916 : 



TABLE 57. 

Mortality from Injuries by Other Vehicles, Classified by Color and 

BY Sex. 

Death Bates per 100,000 Persons 'Exposed. Single Years in Period 1911 

to 1916. 

Experience of Metropolitan Life Insurance Company. Industrial 
Department. 





Persons. 


White. 


Colored. 


Year. 












Males. 


Females. 


Males. 


1911 to 1916 


3.1 


5.7 


.9 


5 6 






1916 


2.8 


5.4 


.7 


6.0 


1915 


3.0 


5.6 


.8 


6.2 


1914 


2.9 


5.4 


.9 


4.4 


1913 


3.4 


6.4 


1.4 


3.6 


1912 


3.4 


6.2 


.9 


7.3 


1911 


3.1 


5.5 


1.0 


6.0 



EXTERNAL CAUSES OF DEATH. 



115 



The death rate for this group of miscellaneous vehicular injuries 
is stationary for the age periods under 10 years, and declines to a 
minimum rate between 10 and 14 years. It then gradually rises 
to a maximum in the age period 65 to 74 years. There was a 
slightly higher rate for white males than for colored males. White 
females had a low rate of .9 per 100,000 exposed. The deaths 
among colored females were too few to give any significance to the 
rates. No figures for this class are therefore presented. 

Traumatism by Machines.* 

A total of 905 deaths from traumatism by machines is recorded. 
It will be understood that this title includes deaths by means of 
machines in most industries and through mechanisms such as ele- 
vators, which are not always concerned in industrial processes. 
This latter fact does not materially affect our figures, however, for 
the main working period in life. The experience available, ac- 
cording to age period, for all persons exposed to risk in this investi- 
gation, and for white males and colored males is shown in the fol- 
lowing table. The experience for females is not significant. 



TABLE 58. 

moetalitt from traumatism by machines,* (classified by color for 

Males, and by Age Period. 

Death Bates per 100,000 Persons Exposed. 1911 to 1916. 

Experience of Metropolitan Life Insurance Company. Industrial 

Department. 



Age Period. 


Persons In Total 
Experience. 


White Males. 


Colored Males. 


AH ages — one and over. . . . 


1.7 


3.4 


4.8 


1 tol4 

15 to 19 

20 to 24 

25 to 34 

35 to 44 

45 to 54 

55 to 64 

65 to 74 

75 and over 


.3 
2.3 
2.1 
1.9 
2.7 
3.2 
3.0 
2.3 
1.9 


.4 
4.2 
4.5 
4.0 
6.7 
7.7 
7.7 
6.0 
1.4 


.5 
5.1 
4.6 
6.5 
6.2 
9.8 
6.6 
1.7 
13.7 



* Deaths caused by machinery accidents in mines and quarries are classi- 
fied under title No. 173 (Traumatism in mines and quarries) ; those due 
to locomotives are charged to one of the subtitles of title No. 175 (Steam 
railroad accidents and injuries). 



116 



MOKTALITY STATISTICS OF INSUEED WAGE EAENEES. 



The rate for white males does not vary much from the fignre of 
four per one hundred thousand between fifteen and thirty-five years 
of age. The rate rises after that age to a figure of 7.7 per one hun- 
dred thousand between forty-five and sixty-five years of age and 
declines thereafter. The rates for this cause of death are, in gen- 
eral, higher among colored males than among white males. The 
maximum rate for colored males was observed in the age period 
forty-five to fifty-four years, when it was 9.8 per 100,000 exposed. 

There was a fairly stationary tendency in the' death rate from 
this cause in the present experience covering the period 1911 to 
1916. The following table gives the facts for each calendar year 
in the investigation: 

TABLE 59. 

moetality from traumatism by machines,* classified by color for 

Males. 
Death Bates per 100,000 Persons Exposed. Single Years in Period 1911 

to 1916. 

Experience of Metropolitan Life Insurance Company. Industrial 

Department. 



Year. 


Persons In Total 
Experience 


White Males. 


Colored Males. 


1911 to 1916 


1.7 


3.4 


4.8 






1916 


1.7 
1.4 
1.5 
2.0 
1.7 
1.8 


3.4 
2.9 
3.3 
4.1 
3.2 
3.4 


5.3 


1915 


3.4 


1914 


2.9 


1913 


5.4 


1912 


5.6 


1911 


6.9 







* See footnote for Table 58 on preceding page. 

A brief comparison of our data with those for the Registration 
Area shows that for the latter part of the main working periods of 
life the death rate from traumatism by machines is higher among 
insured white males than among males in the corresponding age 
groups in the Registration Area of the United States. No precise 
interpretation can be placed upon this fact, however, because we 
do not have any clue as to the approximate number of persons in 
both experiences exposed to risk from machinery. But it is rea- 
sonable to assume that there is a considerably larger proportion 
of persons exposed to machine hazards in a group such as that com- 
prised- in the insurance experience than there is in the general 
population of the Registration Area. 



EXTERNAL CAUSES OF DEATH. 



117 



"^Othee Acute Poisonings"* (Food Poisonings Excepted). 

All accidental poisonings in this experience have been reported 
under two heads: "poisoning by food" and "other acute poi- 
sonings." The second of these titles, which includes the larger 
number of these deaths, relates to those caused by solid or liquid 
poisons, excepting alkaloid products of putrefaction and other poi- 
sons in food products. 

In this experience for insured wage earners 1,144 deaths from 
this specific cause of accidental violence occurred. The rates are 
slightly higher for the colored than for the white of each sex. 

The age and sex characteristics for the white group only are given 
in the following table : 

TABLE 60. 

Mortality from ' ' Other Acute Poisonings, ' '* White Persons Classified 

BY Sex and by Age Period. 

Death Bates per 100,000 Persons Ex-posed. 1911 to 1916. 

Experience of Metropolitan Life Insurance Company. Industrial 

Department. 





Persona In Total 
Experience. 


WMte. 


Age Period. 


Males. 


Females. 




2 1 


2.4 


1 8 








1 to 4 

5 to 9 


7.9 

.8 

.2 

.8 

1.7 

2.2 

2.1 

2.3 

2.7 

3.5 

4.3 


7.6 
1.0 
.3 
.5 
1.4 
2.4 
2.5 
4.3 
4.8 
5.6 
7.1 


7.1 
.5 


10 to 14 

15 to 19 

20 to 24 

25 to 34 

35 to 44 

45 to 54 

55 to 64 

65 to 74 

75 and over 


.2 

1.2 
1.7 
2.2 
1.9 
1.3 
1.8 
2.5 
3.3 



" other acute poisonings " show the maximum death rate under 
5 years of age, the minimum death rate between 10 and 14 years 
and a fairly regularly rising rate thereafter. Between 25 and 54 

* Deaths reported from ' ' poisoning, " " carbolic acid poisoning, " "bi- 
chloride of mercury poisoning," etc., although not reported as accidental, 
are classified here unless identified as due to suicide or homicide. Deaths 
caused by accidental inhalation of poisonous gases are classified under 
another heading; see page 119. 



118 



MORTALITY STATISTICS OF INSUEED WAGE EAENEES. 



years there is a slackening in the rise in the death rate. After 55 
years of age the rate rises again rapidly. The rates for males ex- 
ceed those for females very generally throughout life. 

A slight downward tendency in the death rate for this cause is 
in evidence recently. In 1914 the maximum rate (2.6 per 100,000) 
was registered; the minimum rate was 1.6 per 100,000 in 1916. 
Considering the series of years from 1911 to 1916, we may perhaps 
be justified in concluding that recent efforts toward restriction of 
the sale of poisonous substances have had some favorable influence 
upon the death rate from acute accidental poisonings. We must 
remember, however, that the recently increased tendency to specify 
suicidal and homicidal findings in cases which would have been 
formerly returned as undefined violence, may have had some influ- 
ence in reducing the recorded death rate for acute accidental poi- 
sonings. The following table gives the death rates for " Other acute 
poisonings" (food poisonings excepted) by single calendar years 
during the period 1911 to 1916 classified according to color and 
sex: 

TABLE 61. 

Mortality from "Other Acute Poisonings,"* Classified by Color and 

BY Se:x;. 
Death Bates per 100,000 Persons Exposed. Single Tears in Period 1911 

to 1916. 

Experience of Metropolitan Life Insurance Company. Industrial 

Department. 





Persons. 


White. 


Colored. 


Year. 


Males. 


Females. 


Males. 


Females. 


1911 to 1916 


2.1 


2.4 


1.8 


2.7 


2.0 


1916 

1915 

1914 

1913 

1912 

1911 


1.6 
2:0 
2.6 
2.2 
2.3 
2.2 


1.8 
2.2 
3.3 
2.4 
2.4 
2.3 


1.5 
1.5 
2.1 
1.9 
2.1 
2.2 


1.8 
3.4 
3.5 
3.2 
2.5 
1.7 


1.4 
2.4 
2.1 
1.5 
2.4 
2.2 



See footnote on page 117. 



The available population experience also shows a slightly down- 
ward trend. 



EXTEKNAL CAUSES OF DEATH. 



119 



Absoeption of Deleterious Gases.* 

By far the largest proportion of deaths included under this title 
were caused by accidental inhalation of illuminating gas. There 
was, of course, a significant number of deaths from the absorption 
of other poisonous gases and vapors, such as sewer gas, anesthetic 
vapors, and gases evolved in the domestic and industrial operation 
of stoves and furnaces. 

The following table gives the data for this cause of death with 
respect to color, sex and age classes of the experience: 

TABLE 62, 

Mortality from Absorption of Deleterious Gases,* Classified by Color, 

Sex and by Age Period. 

Death Bates per 100,000 Persons Exposed. 1911 to 1916. 

Experience of Metropolitan Life Insurance Company. Industrial 

Department. 





Persons. 


White. 


Colored. 


Age Period. 


Males. 


Females. 


Males. 


Females. 


All ages — one and 
over 


2.7 


3.9 


1.9 


2.3 


.9 


1 to 4 

5 to 9 

10 to 14 

15 to 19 

20 to 24 

25 to 34 

35 to 44 

45 to 54 

55 to 64 

65 to 74 

75 and over 


1.0 

.7 
.8 


1.0 

.7 
1.2 


1.0 

.7 

.4 

1.2 

1.1 

1.5 

1.7 

3.2 

5.7 

8.6 

18.4 


1.3 

.6 
1.0 
1.6 
2.8 
3.6 
5.5 
1.8 
3.3 


1.3 
.3 
.3 
.6 

1.3 

1.5 
.7 

1.0 
.4 

1.2 


1.1 
1.8 
2.3 
3.4 
5.4 
8.5 
12.2 
20.2 


1.2 

2.7 

3.5 

6.8 

10.1 

15.6 

21.0 

28.4 



There were 1,431 deaths reported for this cause. This number 
of deaths represented a rate of 2.7 per 100,000 persons exposed. 
The highest death rate was recorded for white males, 3.9 per 100, 
000, the next highest for colored males, 2.3 per 100,000, followed 
by the rate for white females, 1.9 per 100,000. The death rate 
from this cause among colored females was .9 per 100,000 of such 
persons exposed. Under twenty years of age the rate for both sexes 
varies from .7 to 1.1 per 100,000 persons exposed. After twenty 

* Deaths reported as due to "asphyxia by gas," ''gas poisoning," "il- 
luminating gas poisoning," etc., although not reported as accidental, are 
classified here unless identified as due to suicide or homicide. 



120 



MOKTALITY STATISTICS OF INSURED WAGE EAENEES. 



years of age it rises gradually from a figure of 1.8 per 100,000 in 
the age group 20 to 24 years to 20.2 in the highest age group in 
this series. Under twenty years of age, only one period shows a 
difference between the death rate for this cause of white males and 
white females. Beginning with the age period 20 to 24 years, how- 
ever, the rate for accidental poisoning by deleterious gases among 
white males was significantly higher than that among white fe- 
males. Thus, for the age period 25 to 34 years, white males showed 
a rate of 3,5 per 100,000 and white females one of only 1.5 per 
100,000. In the two next higher groups the excess of mortality 
among males was even more pronounced. In the age period 55 to 
64 years the death rate for this cause among white males was 15.6 
per 100,000 and among white females 5.7 per 100,000. The death 
rate among colored males wgis much higher after 25 years of age 
than among colored females. 

TABLE 63. 
Mortality from Absorption of Deleterious Gases, Classified by Colob 

AND BY Sex. 
Death Eates per 100,000 Persons Exposed. Single Years in Period 1911 

to 1916. 

Experience of Metropolitan Life Insurance Company. Industrial 

Department. 





Persons. 


White. 


Colored. 


Year. 


Males. 


Females. 


Males. 


Females 


1911 to 1916 


2.7 


3.9 


1.9 


2.3 


.9 


1916 

1915 

1914 

1913 

1912 

1911 


2.9 
2.3 
2.9 
2.5 
3.0 
2.3 


4.5 
3.6 
4.2 
3.4 
4.3 
3.4 


1.8 
1.6 
2.1 
1.9 
2.2 
1.8 


3.3 

1.3 
1.5 
2.2 
3.7 
1.5 


1.4 

.5 

1.3 

1.0 

.7 
.7 



The death rate throughout the period 1911 to 1916 seems to be 
fairly stationary for insured wage earners. It should be recalled 
that in former years a fairly significant number of deaths from 
illuminating gas poisoning was registered under this cause of 
death title which, if more modern methods of certifying causes of 
death had then been in vogue, would have been recorded under 
" suicide by asphyxia." This factor of improvement in the desig- 
nation of illuminating gas deaths as suicides does not affect the 



EXTERNAL CAUSES OF DEATH. 



121 



present figures from 1911 onward as much as it does other figures 
which refer back perhaps fifteen years or more. It should be 
borne in mind, however, in viewing the table on page 130, that this 
matter of increased precision in the certification of causes of death 
may have affected our figures somewhat and that there may have 
been, therefore, an actual, though slight, decline in the death rate 
for this cause of death. 

Teaumatism by Fireaems.* 

Accidental deaths due to injury by firearms were recorded in 
1,029 cases in this mortality experience at a rate of 1.9 per 100,000 
persons exposed. This cause of death has a distinct color and 
sex incidence. The mortality rate among colored lives is decidedly 
in excess of that among white lives. Colored males, for instance, 
show a rate of 8.1 per 100,000 as compared with a rate of 3.0 for 



TABLE 64. 

Mortality from Traumatism by Firearms,* Classified by Color, Sex 

AND BY Age Period. 

Death Bates per 100,000 Persons Exposed. 1911 to 1916. 

Experience of Metropolitan Life Insurance Company. Industrial 
Department. 

















Persona. 


^mte. 


Coiorea. 


Age Period. 


Males. 


Females. 


Males. 


Females. 


All ages — one and 
over 


1.9 


3.0 


.3 


8.1 


1 5 






1 to 4 

5 to 9 

10 to 14 

15 to 19 

20 to 24 

25 to 34 

35 to 44 

45 to 54 

55 to 64 

65 to 74 

75 and over. . 


.9 

1.4 

3.2 

4.0 

2.5 

1.8 

1.5 

.6 

.7 

.8 


.9 
1.9 
5.4 
6.0 
3.5 
2.5 
2.2 
1.2 
1.2 
1.5 


.5 
.4 
.3 
.8 
.2 
.1 
.3 
.2 
.2 
.4 


2.6 

5.8 

10.4 

18.5 

13.5 

10.1 

5.2 

.7 

1.8 

1.7 


3.2 
1.6 
1.6 

.6 
3.7 
1.2 
2.0 

.5 



* Under this title are classified, also, deaths reported from ' ' gunshot 
wound," "shot,'' etc., without qualification as to accidental, suicidal or 
homicidal character. Every effort is made to obtain definite information, 
however, in such cases, and they constitute only a small proportion of the 
1,029 deaths classified here. 



122 



MORTALITY STATISTICS OP INSUEED WAGE EARNERS. 



white males. A death rate of 1.5 per 100,000 is registered for col- 
ored females and a rate of only .3 per 100,000 for white females. 
The table on page 121 presents a statement of the death rates accord- 
ing to the several color, sex and age classes in this investigation. 

Among white males the highest death rate for this means of 
injury occurs between 15 and 19 years of age with a declining 
death rate thereafter up to the advanced ages in this series. Among 
colored males, also, the highest death rate occurs between 15 and 
19 years of age. It will be noted also that the death rate for this 
cause between 5 and 9 years among colored males (5.8 per 100,000) 
is almost as high as the maximum rate for white males (6.0). A 
very large proportion of these deaths in late childhood and in ado- 
lescence are caused by children playing with firearms and by reck- 
less youths in the pursuit of sport. A considerable number, no 
doubt, are of the " didn't know it was loaded " type. At this time 
of life death rates from all causes are at a reasonably low level. A 
further reduction of mortality in late childhood and adolescence 
could be accomplished, no doubt, by concentration upon the single 
fact of accidental death from firearms. 



TABLE 65. 

Mortality from Traumatism by Firearms, Classified by Oolor and 

BY Sex. 
Death Bates per 100,000 Persons Exposed. Single Years in Period 1911 

to 1916. 

Experience of Metropolitan Life Insurance Company. Industrial 

Department. 





Persons. 


White. 


Colored. 


Year. 


Males. 


Females. 


Males. 


Females. 


1911 to 1916 


1.9 


3.0 


.3 


8.1 


1.5 


1916 .... 

1915 .... 
19H .... 
1913 .... 
1912 .... 
1911 .... 


1.9 
1.7 
2.0 
2.2 
2.0 
1.7 


3.1 

2.7 
2.7 
3.5 
3.1 

2.8 


.3 

.4 
.4 
.5 
.3 
.3 


8.4 
5.7 
10.2 
9.3 
7.9 
7.3 


.8 
1.7 
1.9 
1.5 
2.1 
1.1 



The figures for the period 1911 to 1916, unfortunately, do not 
indicate any marked declining tendency in the death rate from this 
cause. The rate for each year approaches closely that for the sex- 
ennium, 1.9 per 100,000 exposed. In recent years in the Eegistra- 



EXTEENAL CAUSES OF DEATH. 123 

tion Area of the United States a practically stationary death rate 
has also been observed. How far the figures in each experience are 
reliable for purposes of determining the general trend of mortality 
from accidental shooting we cannot say at present. A consider- 
able number of deaths have been reported in the more recent years 
of our experience as accidentally due to the use of firearms which 
would have been reported in former years in such manner as to 
justify tabulation under some indefinite title such as "Other ex- 
ternal violence.^' The table on page 122 gives a brief view of the 
course of accidental mortality from firearms during the period 1911 
to 1916. 

Accident Fatalities Arising Out op or in the Course of 
Employment. 

The records of accident mortality of insured wage earners pre- 
sent a very favorable opportunity for the collection of informing 
statistics on fatalities arising out of or in the course of employ- 
ment. We have already observed in the preceding sections a clear 
indication that these industrial policyholders suffer from higher 
accident death rates, almost uniformly, at ages where the occupa- 
tional factor plays a part. Provision was therefore made early in ' 
the course of this study to distinguish and keep a record of those 
deaths where the occupation was clearly the primary cause of the 
accident. The period covered is only five years, from 1912 to 1916, 
inclusive. Although it was not possible to discover every case of 
occupational origin, there is nevertheless sufficient evidence to show 
that the cases overlooked or disguised were relatively few. In order 
to confine the data to the ages at which policyholders are gainfully 
employed the tabulations of deaths due to occupational violence 
have been limited to white males at the ages 15 years and over. 

Thus, between 1912 and 1916, there were recorded 14,151 deaths 
from a group of selected and specific accidental causes of death, 
in which we might reasonably expect that occupation would play an 
important part. This number of 14,151 deaths does not, therefore, 
cover all of the deaths from occupational violence among white 
males 15 years of age and over. The following table gives the total 
number of accidental deaths reported for the specified accidents and 
injuries and the number and percentage of deaths of occupational 
origin : 



124 



MORTALITY STATISTICS OF INSURED WAGE EARNERS. 



TABLE 66. 

Number of Deaths from Specified Accidental Causes of Death and 
Number and Percentage of Such Deaths Due to Occupational 

Stress. 

White Males, Fifteen Years of Age and Over, 1912 to 1916. 

Experience of Metropolitan Life Insurance Company. Industrial 

Department. 



Cause of Death. 



Total Deaths 


No. Deaths of 


Percent. Deaths 


From Specified 


Occupational 


of Occupational 


Form of Violence. 


Origin. 


Origin. 


14,151 


3,963 


28.0 


149 


23 


15.4 


333 


61 


18.3 


665 


41 


6.2 


2,381 


151 


6.3 


2,889 


685 


23.7 


443 


405 


91.4 


585 


473 


80.9 


2,710 


954 


35.2 


710 


137 


19.3 


890 


97 


10.9 


733 


321 


43.8 


205 


133 


64.9 


112 


43 


38.4 


323 


200 


61.9 


311 


4 


1.3 


712 


235 


33.0 



Total Specified Causes .... 

Conflagration 

Burns 

Absorption of deleterious gases . . . 

Accidental drowning 

Traumatism by fall 

Traumatism in mines and quarries 

Traumatism by machines 

Railroad accidents and injuries . . . 
Street car accidents and injuries . . 
Automobile accidents and injuries 
Other vehicular ace. and injuries 
Other crushing ace. and injuries . . 

Injuries by animals 

Electricity — lightning excepted . . . 
Fractures — cause not specified . . . 
Other external violence 



Out of the group of accidents selected from this experience of 
white males, 15 years of age and over, we found 28 per cent, to 
have been certified as arising out of or in the course of emplojonent. 
For the various types of accidents, or means of injury, the per- 
centage of occupational deaths varies. Thus for traumatism in 
mines and quarries the highest percentage of occupational acci- 
dents was registered, namely, 91.4. Under "absorption of dele- 
terious gases " there was recorded the lowest percentage for any of 
the definite types of accidental violence, 6.2. It was found that 24 
per cent, of the falls were certified to have occurred in the course of 
the employment of the deceased. We do not deem it desirable at 
the present time to apply these ratios to any other body of data 
than to the one we have given. Our table and the accompanying 
text will, it is hoped, stimulate further statistical inquiry, perhaps 
in our published official vital statistics, into the number and per- 
centage of deaths from violence arising out of industry. 

An interesting corollary to the foregoing text on the probable 
number of deaths due to occupational causes, is the comparison of 



EXTEKNAL CAUSES OF DEATH. 



125 



the variation from year to year in the ratio of deaths due to such 
occupational stress. The following table gives a survey of this 
situation by single years from 1913 to 1916: 

TABLE 67. 

mortalitt from a group of specified accidental causes of death. 

Number and Percentage of Deaths Due to Occupational Stress. 

Single Years in Period 1912 to 1916. 

Experience of Metropolitan Life Insurance Company. Industrial 

Department. 



Year. 


Total Deaths from 
Group of Specified 
Accidental Causes. 


Number of Deaths of 
Occupational Origin. 


Per Cent. Deaths of 
Occupational Origin. 


1912 to 1916 .... 


14,151 


3,963 


28.0 


1916 

1915 

1914 

1913 

1912 


3,237 

2,742 
2,683 
2,931 
2,558 


816 
638 

777 
948 
784 


25.2 
23.3 
29.0 
32.3 
30.6 



It would appear, therefore, from these figures that the proportion 
of deaths resulting from occupational accidents was on the decline 
during the five years under observation. The increase in the gen- 
eral accident rate for males at the ages 15 years and over must be 
due to other than occupational dangers, to which conclusion much 
other evidence points*- 

Trend of the Death Rate for Accidents. 

The table on page 126 gives the total accident death rate from 
1911 to 1916, qualified according to the color and sex classes of 
our data. 

We observe from the following data a rather variable accident 
death rate. The maximum figure in the total experience was re- 
corded in 1913 at 77.6 deaths per 100,000 persons exposed and the 
minimum in 1915 with a rate of 67.3. Perhaps if we had a longer 
series of annual rates to consider, we should be able to detect a 
slight tendency toward decline in the death rate from accidents of 
all kinds. From the figures at hand we are unable to say definitely 
whether there has been any considerable reduction in the total acci- 
dent rate among insured wage earners. The conditions of grave 
hazard in American life and industry may not have improved, 
therefore, to any great extent. 



126 



MORTALITY STATISTICS OF IN8UKED WAGE EARNERS. 



TABLE 68. 

Mortality from Accidental and Unspecified Forms of Violence,* 

Classified by Color and by Sex. 
Death Bates per 100,000 Persons Exposed. Single Years in Period 1911 

to 1916. 

Experience of Metropolitan Life Insurance Company. Industrial 
Department. 





Persons. 


White. 


Colored. 


Year. 


Males. 


Females. 


Males. 


Females. 


1911 to 1916 


73.0 


115.9 


36.4 


121.4 


38.8 


1916 

1915 

1914 

1913 

1912 

1911 


73.2 
67.3 
69.9 
77.6 
73.8 
77.4 


118.7 
105.8 
109.3 
124.9 
115.2 
123.6 


34.8 
34.7 
36.5 
37.2 
37.2 
38.8 


122.7 
108.5 
118.2 
134.8 
128.4 
116.5 


37.5 
37.7 
35.5 
39.6 
41.2 
41.6 



* War deaths excluded. 



For white females and for colored females we are able to detect a 
fairly consistent but slight downward trend of total accidents. 
This is perhaps an indication that the graver hazards which sur- 
round women in home life have been mitigated in part by the 
various educational and other efforts toward security of the person 
from accidental violence. The white male total accident rate 
fluctuates somewhat from year to year and from a view of the 
figures in our present series we do not feel able to say that there 
has been any marked change for better or worse in the accident 
situation as it affects this group. The colored male total accident 
rate likewise offers no particularly encouraging evidence that the 
graver general accident hazards surrounding wage earners have been 
mitigated to any great extent. 

SuiCIDES.f 

The suicide problem has in recent years attained considerable 
prominence in discussions of the aims and purposes of preventive 

t Under "Suicides" are classified only those cases in which the fact of 
suicide or of attempt at suicide is clearly shown. By careful "editing" 
of our data relating to cause of death, hundreds of eases originally re- 
ported under such terms as "poisoning," "inhalation of gas," ^'drown- 
ings" "gunshot wound," "cut" and others have been added to this 
title instead of being placed under the class "accidental or unqualified," 



EXTERNAL CAUSES OF DEATH. 



127 



medicine. Suicide is often a preventable source of mortality, espe- 
cially when it is recaUed that in many cases the suicidal impulse is 
the end product of a psychosis, which, if treated in good time, might 
have been relieved. That suicide is a serious source of mortality is 
indicated by the fact that in the six-year period of this experience 
6,542 deaths from this cause were recorded. Interest attaches also 
to this mass of deaths because they have occurred among a group 
of wage earners. If, as has been supposed, the suicide death rate 
is a measure of the mental health of a people, the figures at our 
disposal should help us determine an important characteristic of 
the American industrial population in relation to that of other 
groups of the population. In the following table we present a 
statement of the suicide death rates for each of the color and sex 
classes of our data. Chart XIII graphically illustrates these age 
data. 

TABLE 69. 

Mortality from Suicide (All Forms), Classified by Color, Sex and 

BY Age Period. 

Death Bates 'per 100,000 Persons Exposed. 1911 to 1916. 

Experience of Metropolitan Life Insurance Company. Industrial 

Department. 





Persons. 


White. 


Colored. 


Age Period. 


Male. 


Female. 


Male. 


Female. 


All ages — one and 
over 


12.2 


20.1 


6.8 


10.1 


4.9 


ltol4 

15 to 19.. .. 

20 to 24 

25 to 34 

35 to 44 

45 to 54 

55 to 64 

65 to 74 

75 and over . 


.1 
6.0 
13.0 
17.0 
20.9 
26.5 
31.3 
34.0 
34.1 


.2 

5.0 
18.0 
27.9 
42.9 
60.1 
72.8 
79.7 
86.5 


.1 

7.2 
8.7 
11.1 
10.9 
11.1 
10.4 
10.5 
8.4 


.3 

5.1 
14.8 
16.3 
14.8 
12.7 
15.6 
10.0 


.3 
5.3 
11.9 
7.4 
5.7 
3.4 
1.3 
1.2 



At all ages combined, the rate was 12.2 per 100,000 persons ex- 
posed. The group of white males shows the highest rate of any of 
the color or sex classes, followed by colored males, by white females 
and finally by colored females. Males of each color group show 
decidedly higher suicide rates than do females. 



128 



MOETALITY STATISTICS OF INSURED WAGE EAENERS. 



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EXTEKNAL CAUSES OF DEATH. 129 

Suicide Mortality According to Color, Sex and Age. 

The age characteristics of these suicide data are also of signifi- 
cance. Beginning with a rate of 6.0 per 100,000 between 15 and 
19 years, we recorded a rising rate up to and including the highest 
significant age period, 65 to 74 years. The age group 75 years and 
over has been disregarded because of its heterogeneous age com- 
position and the small number of lives exposed and of deaths re- 
ported. This gradual upward slope of the curve for suicide mor- 
tality probably reflects very largely the experience of the white 
male group included in the figures for all persons. For white 
males there is quite a sharp rise in the curve of suicide mortality, 
from a figure of 5.0 per 100,000 between the ages 15 and 19 years 
to a rate of 79.7 per 100,000 at the age period 65 to 74 years. 
White females do not show as clearly this phenomenon of increas- 
ing suicide mortality with age. Beginning with a figure of 7.2 
per 100,000 at the age period 15 to 19 years, there is a gradual in- 
crease to a rate of 11.1 for the age period 25 to 34 years. From 
this group up to and including the period 65 to 74 years there is a 
practically stationary suicide rate for white females, with little 
variation from a figure of 10.5 per 100,000. 

The suicide rate for colored males does not show any tendency 
throughout the entire range of life toward either a decrease or an 
increase with advancing age. After the age period 20 to 24 years 
for colored females, we observe a distinct drop in the suicide rate 
with advancing years, from a figure of 11.9 per 100,000 in the first 
named age period to a rate of 3.4 per 100,000 in the period 45 to 
54 years, the last age group for which we have significant figures. 

In view of the importance of racial characters of suicide mor- 
tality, it will be of some interest to consider the comparative ratios 
of some of these mortality rates for the several color classes by sex 
and age. 

Ratio of Suicide Mortality hy Color. 

In a preceding section we indicated the lower suicide mortality 
rate among colored persons. The colored male suicide rate was 
only 50 per cent, of that shown for white males at all ages combined. 
But this relation varies markedly at the several age periods. Be- 
tween 15 and 19 years our figures indicate a slight excess in the 
colored male suicide rate over the rate for white males, but this may 
be purely accidental and of no real significance. Beginning with 
10 



130 



MOKTALITY STATISTICS OP INSURED WAGE EARNERS. 



the age period 30 to 24 years, the colored male suicide rate becomes 
increasingly more favorable in respect to the white male rate. 
Thus, while colored males showed a suicide mortality rate 82.2 per 
cent, of that recorded for white males at the age period 20 to 24 
years, the ratio was only 12.5 per cent, at the age period 65 to 74 
years. Among colored females also, with the exception of the age 
period 20 to 24 years, we observe with advancing age an increas- 
ingly more favorable suicide rate. The foregoing facts are shown 
in the table given below: 

TABLE 70. 

Mortality from Suicide (All Forms). 

Percentage, Colored of White Mortality at Specified Age Periods for Each 

Sex. 1911 to 1916. 

Experience of Metropolitan Life Insurance Company. Industrial 
Department. 





Percentage, Colored of White Mortality. 


Age Period. 


Males. 


Females. 


All ages — one and over 


50.2 


72.1 




15 to 19 


102.0 
82.2 
58.4 
34.5 
21.1 
21.4 
12.5 


73.6 
136.8 
66.7 
52.3 
30.6 
12.5 
11.4 




20 to 24 




25 to 34 




35 to 44 




45 to 54 




55 to 64 




65 to 74 




75 and over 





Sex Ratio of Suicide Mortality. 

We have shown that for white persons, the female suicide rate was 
less than the male suicide rate, the ratio being about one to three. 
White males show a higher rate of self-destruction at all age periods 
with the exception of the period of 15 to 19 years. 

There is a distinctly higher suicide rate among white females in 
this age of early adolescence than among white males. This phe- 
nomenon is also in evidence in such population figures as we 
have been able to find. It is possible that the stress and strain 
of early adolescence is more disastrous to females than to males. 
We might expect, also, to find a higher index of mental disorders 
among female adolescents than among males of the same ages on 
the basis of these suicide data. It may be noted in this connec- 
tion that there is a much higher incidence rate of serious cases of 



EXTERNAL CAUSES OF DEATH. 



131 



dementia precox, a form of dementia characteristic of adolescence 
and early adult life, among females than among males in popula- 
tions generally. Thus, in New York State during 1916 there were 
in the care of the hospitals for mental diseases under the super- 
vision of the New York State Hospital Commission, 8,903 male and 
10,046 female dementia precox cases. At the ages in the popula- 
tion from which these patients were drawn, there is a considerable 
excess of males. This would make the disparity between the male 
and female dementia precox rates much greater than would be 
indicated by the foregoing comparison of the sex ratios of such 
patients under hospital care. 

Beginning with the age period 20 to 24 years, the white male 
suicide rate shows a very marked excess over the white female rate. 
This excess increases with advancing age. Between 20 and 24 
years the white male suicide rate is 207 per cent, of the white female 
rate, between 25 and 34 years, 251 per cent.; between 35 and 44 
years, 394 per cent., increasing to a percentage of 759 at the age 
period 65 to 74 years. 

TABLE 71. 
Mortality from Suicide (All Forms). 

Percentage, Male of Female Mortality at Specified Age Periods for Each 
Color Class. 1911 to 1916. 

Experience of Metropolitan Life Insurance Company. Industrial 
Department. 





Percentage, Male of Female Mortality. 


Age Period. 


White. 


Colored. 


All agea — one and over 


295.6 


206.1 


15 to 19 


69.4 
206.9 
251.4 
393.6 
541.4 
70O.0 
759.0 
1029.8 


96.2 


20 to 24 


124.4 


25 to 34 


220.3 


35 to 44 


259.6 


45 to 54 


373.5 


55 to 64 


1200.0 


65 to 74 


833.3 


75 and over 





Colored males also show a suicide death rate lower than that for 
colored females at the age period 15 to 19 years, although the 
advantage of the males in relation to the females among the colored 
is not as great as that observed among the white lives. Beginning 
with the age period 20 to 24 years colored males showed a suicide 



132 MOETALITY STATISTICS OF INSUEED WAGE EAENEKS. 

rate 124 per cent, of that recorded for colored females. There is 
much the same precipitate rise in the percentage of excess of male 
suicide mortality among colored persons as we found among white 
persons. The greatest difference is found in age period 55 to 64 
when the rate for colored males is twelve times as high as for col- 
ored females. The foregoing observations are shown in tabular 
form on page 131. 

Suicide Experience of Insured Wage Earners and Population of 
Expanding Registration Area of the United States Compared. 

The suicide rates for white male insured wage earners are more 
favorable than the rates for males in the general population of the 
United States only for the ages under 25 years. Beginning with 
the age period 25 to 34 years we observe excesses in the suicide rate 
of white male wage earners — an excess of 5 per cent, for the period 
25 to 34 years, of 20 per cent, for the period 35 to 44 years, of 17 
per cent, for the period 45 to 54 and of 11 per cent, for the period 
55 to 64 years. In other words, at the ages of early adolescence 
and early adult life white male wage earners show a more favorable 
suicide rate, but continuing through the main working period of 
life and up to the last age group registered in this table, the suicide 
rate of insured white males exceeds, and rises faster, than the rate 
for all males in the general population of the expanding Eegistra- 
tion Area of the United States. 

The suicide experience for insured white females is, however, 
more encouraging. Only between the ages 15 and 19 years and 25 
and 34 years do we find an excess (very negligible) in the suicide 
rate of the insured group over females in the general population. 
For all other age periods, insured white females show a more favor- 
able suicide rate than do females in the population of the expand- 
ing Kegistration Area of the United States. Moreover, between 
the ages 35 to 64 years, insured white females show a tendency to 
improve upon the already favorable ratio of their suicide rate to the 
rate for females in the general population. Between 35 and 44 
years insured white females showed a rate 96.5 per cent, of that 
recorded for females in the general population ; between 45 and 54 
years, a rate of 88.8 per cent., and between 55 and 64 years, a rate 
78.2 per cent, of that recorded for females in the general population. 
These observations are shown in the following table : 



EXTERNAL CAUSES OF DEATH. 



133 



TABLE 72. 

Mortality from Suicide (All Forms). 

Death Bates pet 100,000 Persons Exposed. Clctssified by Sex and hy Age 
Period. Insured White Lives in Experience of Metropolitan Life In- 
surance Company, Industrial Department {1911 to 1916) and 
General Population Experience of Expanding Begistra- 
tion Area of the United States (1910 to 1915). 





Males. 


Females. 


Age Period. 






Percentage 






Percentage 




M. L. I. Co. 


U. S. Reg. 


M. L. I. Co 


M. L. I. Co. 




M. L. I. Co. 




(White). 


Area. 


of Reg. Area. 


(White). 


Area. 


of Reg. Are*. 


All agea — one 














and over .... 


20.1 


24.6 


81.7 


6.8 


7.9 


86.1 


1 to 14 


.2 


.6 


33.3 


.1 


.5 


20.0 


15 to 19 


5.0 


5.6 


89.3 


7.2 


7.1 


101.4 


20 to 24 


18.0 


18.2 


98.9 


8.7 


10.7 


81.3 


25 to 34 


27.9 


26.7 


104.5 


11.1 


11.0 


100.9 


35 to 44 


42.9 


35.8 


119.8 


10.9 


11.3 


96.5 


45 to 54 


60.1 


51.4 


116.9 


11.1 


12.5 


88.8 


55 to 64 


72.8 


65.8 


110.6 


10.4 


13.3 


78.2 


65 to 74 


79.7 


61.6 


129.4 


10.5 


11.6 


90.5 


75 and over. 


86.5 


61.5 


140.7 


8.4 


9.8 


85.7 



Suicide According to Principal Means of Injury. 
The above discussion reviewed the principal facts of the suicide 
experience in the aggregate. A more intimate view, however, is 
afforded by a brief consideration of this phenomenon of self- 

TABLE 73. 

Mortality prom Suicide (All Forms). 

Number of Deaths, and Percentage of Deaths According to Specified Means 

of Injury. 1911 to 1916. 

Experience of Metropolitan Life Insurance Company. Industrial 

Department. 



Means of Injury. 


Number of Deaths. 


Percentage of Total. 


StnciDES — Total 


6,542 


100.0 






Suicide by 
Poison 


2,352 

1,040 

761 

316 

1,519 

346 

107 

33 

68 


36.0 


Asphyxia 


15.9 


Hanging or strangulation . 
Drowning 


11.6 

4.8 


Firearms 


23.2 


Cutting or piercing 

instrunaents 

Jumping from high places. 
Crushing 


5.3 

1.6 

.5 


Other suicides 


1.0 



134 MOETALITT STATISTICS OF INSUEED WAGE EAKNERS. 

destruction according to the means of injury employed. In the 
preceding table we display the number of deaths reported accord- 
ing to the chief means of injury employed, and the percentage that 
each "means of injury" class constitutes of the total. 

Poison was the chief means of suicide in the present experience. 
Of the total deaths from suicide, 36.0 per cent, were accomplished 
by this means. This ratio is, of course, not constant in all mor- 
tality experiences. For instance, in New York City, asphyxia is 
the principal mode of committing suicide for both males and fe- 
males and in the Registration Area of the United States it would 
seem that firearms were the chief means of suicidal injury as re- 
gards males. Poisoning seems to be the mode most frequently 
chosen by females in the Registration Area, corresponding prac- 
tically to the prevalence shown in the experience of the Industrial 
Department of this Company. Variation in the choice of means 
of suicidal injury depends, of course, upon numerous factors, such 
as legislative restriction upon the sale of poisons, firearms and other 
means of injury, the extent to which publicity is given to suicides 
in the newspapers of various localities, and other strictly local fac- 
tors difficult to enumerate. "We shall take up briefly the principal 
means of suicidal injury in this present experience. 

Suicide hy Poison* 

There were 2,352 deaths from this cause concerned in the present 
investigation, in which either solid or liquid poisonous substances 
were employed. These deaths corresponded to a rate of 4.4 per 
100,000 persons exposed. The age and sex characteristics of this 
cause of death are shown in Table 74 on page 135. 

It will be seen that the maximum rate in the entire group for 
suicide by poison is that among white males in the age period 55 
to 64 years. Among white females and colored males, the maxi- 
mum figure is found in the age period 25 to 34 and among colored 
females even earlier, between 20 and 24 years. 

The general trend of mortality from suicide by poison seems to 
be downward. This is indicated by the figures given in Table 75 
on page 135. 

* Solid and liquid poisons only. Where poisonous gas is the means em- 
ployed the death is classified under "Suicide by Asphyxia." 



EXTEKNAL CAUSES OF DEATH. 



135 



TABLE 74. 
Mortality from Suicide by Poison, Classified by 'Color, Sex and by 

Age Period. 

Death Bates per 100,000 Persons Exposed. 1911 to 1916. 

Experience of Metropolitan Life Insurance Company. Industrial 

Department. 





Persons. 


White. 


Colored. 


Age Period. 


Males. 


Females. 


Males. 


Females. 


All ages — one and 
over 


4.4 


6.0 


3.4 


2.9 


3.0 


1 to 14 

15 to 19 

20 to 24 

25 to 34 

35 to 44 

45 to 54 

55 to 64 

65 to 74 

75 and over . 


t 
3.3 
6.2 
7.7 
7.5 
7.3 
8.1 
7.3 
3.8 


t 

1.7 

6.7 
10.7 
14.1 
15.0 
17.6 
16.7 

8.5 


.1 
5.0 
5.9 
6.3 
4.5 
4.0 
3.7 
2.7 
1.7 


.1 
1.3 
3.0 
6.2 

4.8 
3.3 

1.8 


3.8 
8.5 
4.9 
3.1 
1.0 
.4 



t Less than .05 per 100,000. 

From a rate of 5.4 per 100,000 in 1911 the decline was fairly 
regular to a rate of 2.8 per 100,000 in 1916. We must remember, 
however, that suicide mortality is subject to considerable fluctua- 
tion with community conditions and that an opinion on the real 
trend of this phenomenon must be founded upon facts over a long 



TABLE 75. 

Mortality from Suicide by Poison, Classified by Color and by Seix. 
Death Bates per 100,000 Persons Exposed. Single Years in Period 1911 

to 1916. 

Experience of Metropolitan Life Insurance Company. Industrial 
Department. 





Persons. 


White. 


Colored. 


Year. 














Males. 


Females. 


Males. 


Females. 


1911 to 1916 


4.4 


6.0 


3.4 


2.9 


3.0 


1916. . . . 


2.8 


3.5 


2.4 


2.4 


1.8 


1915.... 


3.8 


4.9 


3.4 


.9 


2.8 


1914.... 


4.8 


6.8 


3.4 


3.7 


3.7 


1913.... 


5.1 


7.1 


3.7 


4.6 


3.1 


1912.... 


4.8 


6.6 


3.7 


4.1 


2.4 


1911... 


5.4 


7.7 


4.1 


1.9 


4.1 



136 



MORTALITY STATISTICS OF INSURED WAGE EARNERS. 



period of time and only after the fluctuations characteristic of sui- 
cide are in full view. 

Suicide hy Asphyxia. 

The experience for this cause of death among white males and 
females according to age periods is shown in the following table. 
No substantial facts for colored persons are available. 

TABLE 76. 

MOETALITT FROM SUICIDE BY ASPHYXIA, CLASSIFIED BY SeX FOR WHITE 

Lives and by Age Period. 

Death Bates per 100,000 Persons Exposed. 1911 to 1916. 

Experience of Metropolitan Life Insurance Company. Industrial 
Department. 





Persons in Total 
Experience. 


White. 


Age Period. 


Males. 


Females. 


All ages — one and over 


1.9 


3.0 


1.5 


lto24 

25 to 34 

35 to 44 

45 to 54 

65 to 64 

65 to 74 

75 and over 


.3 
2.2 
3.9 
5.3 
6.2 
6.7 
3.4 


.3 

3.4 

6.3 

10.4 

13.3 

14.4 

5.7 


.2 
2.1 
3.6 
3.6 
2.8 
3.0 
2.5 



The rates represented in the foregoing table were based upon 
1,040 deaths from suicide by asphyxia. The rate for males from 
this cause is, at all ages combined, twice as high as that for white 
females. There is a constant increase in the rate with age for 
white males throughout the significant age groups but no very 
material variation for white females. The general trend of the 
rate for suicide by asphyxia during the six years under observa- 
tion is shown in the table on page 137. 

There is a practically constant death rate for this cause. Such 
variations as do occur are of no particular moment. If anything, 
there seems to be a slight increase in the rate for white females. 
In the expanding Eegistration Area of the United States, also, 
there has been observed in recent years a slight increase in the re- 
corded death rate from suicide by asphyxia, but this may be almost 
entirely due to an increase in the precision of reporting on the part 
of coroners, physicians and others entrusted with the completing of 
death certificates. 



EXTERNAL CAUSES OF DEATH. 



137 



TABLE 77. 

Mortality fkom Suicide by Asphyxia, Classified by Sex roa White 

Lives. 
Death Bates per 100,000 Persons Exposed. Single Years in Period 1911 

to 1916. 

Experience of Metropolitan Life Insurance Company. Industrial 

Department. 





Persons In Total 
Experience. 


WWte. 


Year. 


Males. 


Females. 


1911 to 1916 


1.9 


3.0 


1.5 






1916 


1.9 
2.3 
1.9 
2.1 
1.7 
1.7 


2.5 
3.4 
3.1 
3.5 
2.4 
2.8 


1.8 


1915 


1.9 


1914 


1.2 


1913 


1.5 


1912 


1.5 


1911 


1.1 







Suicide by Hanging or Strangulation. 

Only 761 deaths from this cause were recorded. This number 
does not justify any detailed analysis according to age classes. It 
will be suflBcient to remark that the death rate for this cause was 
practically the same among white males as the death rate from sui- 
cide by asphyxia. For white females and for colored persons the 
data are of no significance. The total number of deaths registered 
was 761; of these 626 were those of white males. 

Suicide by Drowning. 

There were only 316 deaths from this form of suicide. White 
males showed the highest rate ; white females had a death rate about 
half that of white males. 



Suicide by Firearms. 

The use of firearms was next in importance to poison among the 
cases of suicide represented in this mortality experience. We re- 
corded in all 1,519 deaths at a rate of 2.8 per 100,000 exposed. 
The mortality rate varied quite sharply according to sex, there being 
an almost negligible rate among females of both color or race 
classes. Our facts for color, sex and age are given in the following 
table : 



138 



MOETALITY STATISTICS OF INSUEED WAGE EAENEES. 



TABLE 78. 
Mortality from Suicide by Firearms, Classified by Color, Sex and 

BY Age Period. 

Death Bates per 100,000 Persons Exposed. 1911 to 1916. 

Experience of Metropolitan Life Insurance Company. Industrial 

Department. 





Persons. 


White. 


Colored. 


Age Period. 


Males. 


Females. 


Males. 


Females. 


All ages — one and 
over 


2.8 


5.7 


.6 


4.2 


.8 






1 to 14 

15 to 19 

20 to 24 

25 to 34 

35 to 44 

45 to 54 

55 to 64 

65 to 74 

75 and over . . 


t 
1.3 
4.1 
3.9 
4.7 
6.1 
6.6 
6.0 
7.2 


.1 

1.9 

7.3 

8.1 

11.7 

16.5 

17.8 

16.5 

21.3 


.8 
1.5 
1.0 
.9 
.7 
.4 
.3 


.1 
1.9 
7.9 

7.2 
5.6 
5.2 
4.8 
3.3 


.1 

.6 
1.1 
1.3 
1.0 

.8 
.4 



t Less than .05 per 100,000. 

The chief fact of importance in this table is the practically sta- 
tionary rate between 45 and 75 years of age. The trend of the 
mortality from this cause is displayed in the following table : 

TABLE 79. 
Mortality from Suicide by Firearms, Classified by Color and by Sex. 
Death Bates per 100,000 Persons Exposed. Single Years in Period 1911 

to 1916. 

Experience of Metropolitan Life Insurance Company. Industrial 

Department. 





Persons. 


WMte. 


Colored. 


Year. 


Males. 


Females. 


Males. 


Females. 


1911 to 1916 


2.8 


5.7 


.6 


4.2 


.8 


1916 

1915 

1914 

1913 

1912 

1911 


2.5 
2.8 
2.7 
3.1 
2.9 
3.0 


4.8 
5.5 
5.4 
6.5 
6.1 
5.9 


.6 
.6 
.7 
.6 
.4 
.5 


4.2 

4.3 
3.7 
4.2 
5.0 
4.1 


.6 
.9 
.8 
.5 
.5 
1.3 



The figures at hand relate to so few calendar years that no final 
conclusion can be drawn on the general trend of suicide by firearms. 



EXTERNAL CAUSES OF DEATH. 



139 



We can say at a venture that a slight decrease was observed. The 
underlying causes of mortality from suicide by firearms are en- 
tirely too complex to make it possible for us to speculate in any 
great detail upon the data shown in the foregoing table. 

Homicide.* 

The facts on homicide among this group of insured wage earners 
form an important contribution to the statistics on the crime of 
homicide in the United States. In fact, there are not available in 
discussions of the homicide problem any such detailed, modern data 
according to age classes of the two main race groups in the popu- 
lation as are to be found in this present display. In this investi- 
gation there were recorded 3,753 homicides and these deaths rep- 
resent a rate of 7.0 per 100,000 persons exposed. The following 
table gives a statement of the number and percentage of homicide 
deaths according to the several means of injury employed: 



TABLE 80. 

Mortality from Homicide (All Forms).* 

Number of Deaths, and Percentage of Deaths, According to Specif 

Means of Injury. 1911 to 1916. 

Experience of Metropolitan Life Insurance Company. Industrial 

Department. 



Means ot Injury. 


Number of Deaths. 


Percentage of Total. 


Homicides — Total 


3753 


100.0 






Firearms 


2435 

616 
702 


64.9 


Cutting or piercing 

instruments 

Other homicides 


16.4 

18.7 



Of these homicides, 64.9 per cent, were accomplished through 
the use of firearms. This proportion is slightly in excess of that 
for the general population of the expanding Eegistration Area 
(61.8). Homicide by means of cutting or piercing instruments 

* Under ' ' Homicide ' ' are classified only those cases in which the fact of 
homicide or of attempt at homicide is clearly shown. By careful "editing" 
of our data relating to causes of death many eases originally reported 
under such terms as "gunshot wound," "cut," "poisoning," and others 
have been classed as homicides instead of being placed under the "acci- 
dental or unqualified" group. 



140 MORTALITY STATISTICS OP INSURED WAGE EARNERS. 

was recorded in the present investigation in 16.4 per cent, of all 
homicides. In the general population of the Eegistration Area 
only 14.2 per cent, were accomplished through this means. 

The homicide death rate in this insurance experience was nearly 
7^ times as great for colored males as for the entire group of 
insured wage earners. This rate (52.2 per 100,000) was almost ten 
times that of white males (5.4 per 100,000). Among colored 
females there was registered a death rate for homicide of 14.1 
per 100,000 exposed. This rate is nearly three times that recorded 
for white males and over seven times the rate for white females. 
In the following table and in Chart XIV, page 141, we give a com- 
parison of the homicide death rates in this insurance experience 
according to color, sex and age classes : 

TABLE 81. 

MOBTAUTT FROM HOMICIDE (AlL FOBMS), CLASSIFIED BY COLOR, SeX AND 

BY Age Period. 

Death Bates per 100,000 Persons Exposed. 1911 to 1916. 

Experience of Metropolitan Life Insurance Company. Industrial 

Department. 





Persons. 


White. 


Colored. 


Age Period. 


Males. 1 Females. 


Males. 


Females. 


All ages — one and 
over 


7.0 


5.4 1.9 


52.2 


14.1 


1 tol4 

15 to 19 

20 to 24 

25 to 34 

35 to 44 

45 to 54 

55 to 64 

65 to 74 

75 and over . 


.7 

5.8 

12.5 

16.0 

11.4 

7.3 

4.6 

2.8 

3.4 


.6 
4.4 
8.5 
11.8 
10.5 
9.4 
7.3 
4.1 


.6 
2.1 
3.6 
3.3 

2.8 
1.9 
1.3 
1.1 
1.7 


3.1 
40.6 
95.6 
106.0 
66.6 
40.1 
19.2 
13.4 
41.2 


1.1 

14.1 

30.1 

26.6 

13.4 

6.8 

5.7 

2.3 

18.1 



The age period of maximum incidence for males in both color 
classes was the same — 25 to 34 years. For white and colored fe- 
males the maximum rate occurred at an earlier period, 20 to 24 
years of age. Among colored males this maximum rate was 106 
per 100,000 exposed. Homicide among colored males was one of 
the chief causes of death, ranking next to pneumonia in order of 
numerical importance at this age period in Life. It will be noted, 



EXTERNAL CAUSES OF DEATH. 



141 



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142 



MORTALITY STATISTICS OF INSURED WAGE EAENERS. 



however, that the age period 20 to 34 years had only a slightly 
lower homicide rate, 95.6 per 100,000 exposed. 

Homicide assumes alarming proportions as a cause of death 
among the colored population of the United States. No conve- 
nient or all-inclusive explanation of this phenomenon among col- 
ored persons can be made in this present discussion. The homicide 
problem is entirely too grave and grows out of so many other com- 
plex social situations that we cannot, at the present time, do more 
than to indicate the necessity for a further and qualified inquiry 
into the problem. 

The ratio of the homicide rates for white and colored persons, 
according to sex, may be pointed out, however, in passing. The 
following table gives a convenient view of the ratios of white and 
colored mortality at the several age periods in each sex: 



TABLE 82. 

Mortality from Homicide (All Forms). 

Percentage, Colored of White Mortality at Specified Age Periods for Each 

Sex. 1911 to 1916. 

Experience of Metropolitan Life Insurance Company. Industrial 

Department. 





Percentage, Colored of White Mortality. 


Age Period. 


Males. 


Females. 


All ages — one and over 


966.7 


742.1 


15 to 19 


922.7 
1124.7 
898.3 
634.3 
426.6 
263.0 
326.8 
-t 


671.4 


20 to 24 


836.1 


25 to 34 


806.1 


35 to 44 

45 to 54 


478.6 
357.9 


55 to 64 


438.5 


65 to 74 


209.1 


75 and over 


1064.7 



f No deaths of white males from homicide in this age period. 

It will be seen that for the entire experience the homicide rate 
for colored males is practically ten times that of white males. At 
the age period 30 to 34 years the colored male homicide rate is more 
than eleven times that of the white male rate. There is a tendency 
toward decrease in this ratio with advancing age. At all ages, 1 
and over, in this experience, colored females show a homicide rate 
nearly 7^ times that of white females. At the age period 30 to 34 
years colored female homicide mortality is more than 8^ times the 



EXTERNAL CAUSES OF DEATH. 



143 



rate for white females. Between 25 and 34 years, homicide among 
colored females is still more than eight times as prevalent as among 
white females*. 

We may inquire briefly also into the sex ratio of homicide mor- 
tality according to age period for each of the color classes. The 
facts available are shown in the following table : 

TABM:. 83. 
Mortality from Homicide (All Forms). 

Percentage, Male of Female Mortality at Specified Age Periods for Each 

Color Class. 1911 to 1916. 

Experience of Metropolitan Life Insurance Company. Industrial 

Department. 





Percentage, V[ale of Female Mortality. 


Age Period. 


White. 


Colored. 


All ages — one and over 


284.2 


370.2 


15 to 19 


209.5 
236.1 
357.6 
375.0 
494.7 
561.5 
372.7 
-t 


287.9 


20 to 24 


317.6 


25 to 34 


398.5 


35 to 44 


497.0 


45 to 54 


589.7 


55 to 64 


336.8 


65 to 74 


582.6 


75 and over 


227.6 



f No deaths of white males from homicide in this age period. 



Males among white persons show a homicide death rate nearly 
three times that of females. For the colored race, males have a 
homicide death rate nearly 3f times that of females. The excess 
of the homicide rate for males over the rate for females increases 
with age np to the period 55 to 64 years among white persons and 
up to the period 45 to 54 years among colored persons. 

Homicide Rate Among Insured Wage Earners and Among Popula- 
tion of the Expanding Registration Area of the United 
States Compared. 

We offer on page 144 a comparison of the homicide death rates 
among white persons in the insurance experience and among all 
persons in the Eegistration Area experience. 

These two groups are in many respects comparable. It must 
be remembered, however, that the statistics for the expanding Eeg- 
istration Area of the United States are affected by a small propor- 



144 



MOETALITY STATISTICS OF INSUEED WAGE EAENEES. 



tion of colored persons, about 5 per cent. In view, however, of the 
extraordinarily high homicide rate among this latter group of the 
population, the figures for the total population as to homicide are, 
undoubtedly, a little higher than they would be had it been possible 
to exclude this statistical group. Thus, in making this present 
comparison, we must bear in mind that about 5 per cent, of the 
population material is affected by a homicide death rate between 
seven and ten times as high as that of white persons. This one 
fact may be sufficient in itself to account for the exceptionally 
favorable homicide figures among insured white males and females 
shown in the following table: 

TABLE 84. 
Mortality from Homicide (All Forms). 
Death Bates per 100,000 Persons Exposed. Classified by Sex and ty Age 
Period. Insured White Lives in Experience of Metropolitan Life In- 
surance Company, Industrial Department {1911 to 1916) and 
General Population Experience of Expanding Eegistra- 
tion Area of the United States (1910 to 1915). 





Males.- 


Females. 


Age Period. 


M. L. I. Co. 

(White). 


U. S. Reg. 
Area. 


Percentage 
M. L.I. Co. 
of Reg. Area. 


M. L. I. Co. 
(White). 


U. S. Reg. 
Area. 


Percentage 
M, L. I. Co. 
of Reg. Area. 


All ages — one 
and over .... 


5.4 


10.4 


51.9 


1.9 


2.7 


70.4 


1 to 14 


.6 


.9 


66.7 


.6 


.7 


85.7 


15 to 19 


4.4 


6.1 


72.1 


2.1 


3.0 


70.0 


20 to 24 


8.5 


16.9 


50.3 


3.6 


5.0 


72.0 


25 to 34 


11.8 


19.3 


61.1 


3.3 


4.7 


70.2 


35 to 44 


10.5 


16.6 


63.3 


2.8 


3.5 


80.0 


45 to 54 


9.4 


11.7 


80.3 


1.9 


2.1 


90.5 


55 to 64 


7.3 


8.1 


90.1 


1.3 


1.5 


86.7 


65 to 74 


4.1 


5.7 


71.9 


1.1 


1.2 


91.7 


75 and over . . 


— 


3.7 


— 


1.7 


1.6 


106.3 



For all ages one and over the homicide rate for insured white 
males was only 52 per cent, of that among all males in the expand- 
ing Eegistration Area of the United States. Among insured white 
females the homicide rate was only 70 per cent, of the rate prevail- 
ing in the Eegistration Area group of females. Beginning with the 
age period 25 to 34 years, however, there is, with unimportant ex- 
ceptions, an increasing tendency toward equality in the homi- 
cide rates of the two experiences. At the age period 55 to 64 years. 



EXTERNAL CAUSES OF DEATH. 



145 



insured white males have a homicide rate only 10 per cent, more 
favorable than that of males in the population experience. 

Trend of the Death Rate for Homicide. 

In the experience for insured wage earners we observe a fluctuating 
rate from this cause, with no distinct upward or downward tend- 
ency for any of the color or sex classes, with the possible exception 
of colored males for whom there was perhaps a tendency toward 
increase. The 1916 death rate for homicide, compared with the 
1911 rate, showed a slight decrease for white males, a constant rate 
for M^hite females, an increase of practically eight points per 100,000 
for colored males and a decrease for colored females. It will be 
recalled that the suicide rate during 1916 showed a tendency to 
reflect the conditions of unprecedented prosperity which prevailed 
throughout the sections of the country where the Company does 
business among wage earners. This condition of generally better 
economic status for the industrial population of the United 
States apparently did not affect the homicide death rate, however, 
probably because there is no very close connection between the 
homicidal impulse and material well-being. The crime of homi- 
cide is precipitated, perhaps, in persons afflicted with various types 
of mental and nervous defects and diseases, by other than economic 
stresses and circumstances. In the following table we give a state- 
ment of the trend of ^;he homicide death rate during the six years 
of this present investigation : 

TABLE 85. 
Mortality btiom Homicide (All Forms), Classified by Color and by Sex, 
Death Bates per 100,000 Persons Exposed. Single Years in Period 1911 

to 1916. 

Experience of Metropolitan Life Insurance Company. Industrial 

Department. 





Persona. 


White. 


Colored. 


Year. 


Males. 


Females. 


Males. 


Females. 


1911 to 1916 


7.0 


5.4 


1.9 


52.2 


14.1 


1916 

1915 

1914 

1913 

1912 

1911 


6.9 
6.9 
7.0 

7.2 
6.7 
7.2 


5.4 
5.5 
5.5 
4.8 
5.2 
5.9 


2.0 
2.0 
1.9 
2.1 
1.6 
2.0 


54.0 
49.9 
54.0 
57.8 
50.4 
46.2 


14.3 

15.8 
12.6 
13.1 
12.8 
15.9 



11 



146 MORTALITY STATISTICS OP INSURED WAGE EARNERS. 

In the experience of the general population of the Registration 
Area we observe, likewise, a practically stationary death rate from 
the crime of homicide. It must be remembered, however, that 
between 1911 and 1915, the period for which population data are 
available at the present writing, a number of areas containing a 
large number of colored persons were added to the registration 
record and that this fact in itself had a tendency to slacken a slight 
decrease in homicide, if any such really existed. 



CHAPTEE IX. 

Cancer (All Forms). 

Although there have appeared many and important contributions 
to the mortality statistics of cancer in recent years, none of these 
has presented the facts in such detail as to show the incidence of 
this condition in the several age periods of life with the further 
distinction of sex and of color or race of the population. This is 
the merit of the data presented herewith. They are to our knowl- 
edge original in the cancer literature and should well serve the 
nation-wide movement for the control of the disease. Many dis- 
cussions which have centered around the cancer problem in recent 
years, such as the supposed increase of mortality and other ques- 
tions, can be settled only as we know for a period of years the 
detailed facts of mortality for a relatively constant population. 
The present experience meets this requirement admirably and has 
the further merit that it reflects conditions in a large industrial 
group among whom, as will be shown later, cancer takes a heavy 
toll. 

Special efforts were made in the course of the present inquiry to 
have the basic data as reliable as possible. Physicians certifying 
the causes of death often returned statements of cancer unqualified 
as to the organ or part affected. In such instances, letters of in- 
quiry were written and the physicians were asked to specify the 
type of tumor or cancer and the organs or parts first affected by 
the growth. The effect of this correspondence has been to increase 
the precision of the statistical results for cancer. While the data 
were not refined to the same point of completeness as characterized 
the recent investigation of the United States Bureau of the Cen- 
sus, the effort was made to cover fully the various parts and or- 
gans specified in the International List of Causes of Death. 

During the six year period of this investigation, 37,666 cancer 
deaths were recorded at a rate of 70.0 per 100,000 persons exposed. 
Cancer was the sixth cause in order of numerical importance in 
this study. These deaths constituted 5.9 per cent, of all the deaths 

147 



148 



MOKTALITY STATISTICS OF INSUEED WAGE EAKNEES. 



in the experience. In the following table, the facts are arranged 
so as to show the number of deaths from cancer of the various 
organs or parts, and a few derivative ratios, including the death 
rates per 100,000 persons exposed, are given: 



TABLE 86. 

Mortality from Cancer, Specified According to Organs or Parts 

Affected. 

Deaths, and Beaih Bates per 100,000 Persons Exposed. 
All Color and Sex Groups Combined. 

Experience of Metropolitan Life Insurance Company. Industrial Depart- 
ment. 1911 to 1916. 



Organ or Part A fleeted. 



Cancer — All Forms 

Cancer of the: 

Buccal cavity 

Stomach, liver 

Peritoneum, intestines, 

rectum 

Female genital organs 

Breast 

Skin 

Other organs, or of organs 

not specified 



All Color and Sex Groups In Mortality Experience. 



No. of 
Deaths. 



37,666 



1,353 
14,153 

4,482 

7,882 

3,579 

938 

5,279 



Per Cent, of 

Total — All 

Causes. 



5.9 



.2 

2.2 

.7 
1.2 



Per Cent, of 
Total Can- 
cer Deaths. 



100.0 



3.6 
37.6 

11.9 

20.9 

9.5 

2.5 

14.0 



Death Rate 

per 100,000 

Exposed. 



70.0 



2.5 
26.3 

8.3 

14.7 

6.7 

1.7 

9.8 



Cancer and other malignant tumors of the stomach and liver con- 
stituted the largest single group of malignant growths, with 37.6 
per cent, of all cancers, at a rate of 26.3 per 100,000 persons ex- 
posed. Cancer of the female genital organs was next in import- 
ance, with 7,882 deaths, constituting 20.9 per cent, of all cancer 
deaths with a rate of 14.7 per one hundred thousand persons of 
both sexes. Cancers affecting the peritoneum, intestines and 
rectum followed with 4,482 deaths, in all 11.9 per cent, of all 
cancers at a rate of 8.3 per 100,000. These death rates, however, 
vary considerably with age and sex. In the following table, we 
give a comparison of the general cancer mortality experience for 
each of the main color and sex classes, showing separately the facts 
for cancer of the various organs or parts. The age data will be 
presented later. 



CANCEE. 



149 



TABLE 87. 

MORTAUTT FtWM CANCER, CLASSIFIED ACCORDING TO ORGANS OR PARTS. 

Percentage of Deaths, all Causes, and Death Rates per 100,000 Persons 
Exposed. By Color and by Sex. 1911 to 1916. 

Experience of Metropolitan Life Insurance Company. Industrial Depart- 





ment. 


1911 


to 1 


916. 














Total Ex- 
|)erlence. 


White 

Males. 


White Fe- 
males. 


Colored 

Malea. 


Colored Fe- 
males. 


Organ or Part Affected. 


y s S 

< 


S 2 

Q 


.go 
< 


2 . 

OJ O 

i 2 




2 

Ph O 

S 2 

a 


oS °5 


5 as 


^ 1 i 

^0 = 


2 


Cancer — All Forms. . 


5.9 


70.0 


4.3 


50.4 


8.5 


88.4 


1.8 


31.0 


6.2 


87.8 


Cancer of the: 

Buccal cavity 

Stomach, liver. . . . 

Peritoneum, intes- 
tines, rectum . . . 

Female genital 
organs 


.2 
2.2 

.7 

1.2 
.6 
.2 

.8 


2.5 
26.3 

8.3 

14.7 
6.7 
1.7 

98 


.4 
2.1 

.6 

* 
.2 

1 


4.6 

24.8 

6.6 

.1 

2.2 

1^0 


.1 
2.9 

1.0 

2.4 
1.1 

.2 

8 


.9 
29.8 

10.5 

25.3 

11.7 

1.6 

86 


.1 
.9 

.2 

* 
* 

4 


2.5 
16.2 

3.4 

.3 

.8 

79 


.1 
1.1 

.4 

2.2 

.9 

* 

4 


1.3 
18.5 

7.2 

37 9 


Breast 


147 


Skin 


7 


Other organs or of 
organs not spec- 
ified 


7 3 























Less than .05 per cent. 



We see from this table that for all ages one and over combined, 
white persons show higher cancer death rates than colored persons, 
although the white female rate is only slightly higher than that 
for colored females. Various differences between the cancer death 
rates of the color and sex classes occur for this disease as it affects 
various organs or parts. White males, for instance, show uni- 
formly higher cancer death rates for each of the organs or 
parts than are in evidence for colored males. White females 
show significantly lower cancer death rates for this disease only as 
it affects the female genital organs and the breast. Cancer of the 
uterus and of the other genital organs shows a rate of 35.3 per 
one hundred thousand white females exposed and a rate of 37.9 
for colored females. Cancer of the breast, in this present mortality 
experience, was recorded at a rate of 11.7 per one hundred thou- 
sand white females, and at a rate of 14.7 per one hundred thou- 
sand colored females. For the other chief organs or parts, cancer 
mortality of white females is greater than among colored females. 



150 



MOETALITT STATISTICS OF INSURED WAGE EAENERS. 



In a later part of this present section, we shall bring out in greater 
detail the age characteristics of this cancer mortality experience 
for the several color and sex classes, and with distinction of the 
several organs and parts. We quote below our general cancer death 
rates per one hundred thousand persons exposed in each of the 
color and sex classes for the various age periods. Chart XV 
shows the course of the cancer death rates in the experience ac- 
cording to age, for each of the color and sex classes. 



TABLE 88. 

Mortality from Cancer, All Forms, Classified by Color, Sex and by 

Age Period. 

Death Bates per 100,000 Persons Exposed. 1911 to 1916. 

Experience of Metropolitan Life Insurance Company. Industrial 
Department. 





Persons. 


White. 


Colored. 


Age Period. 


Males. 


Females. 


Males. 


Females. 


All ages — one and 
over 


70.0 


50.4 


88.4 


31.0 


87.8 






1 to 4 

5 to 9 

10 to 14 

15 to 19 

20 to 24 

25 to 34 

35 to 44 

45 to 54 

55 to 64 

65 to 74 

75 and over . . 


3.7 

1.4 

1.3 

2.8 

4.1 
15.7 
76.2 
198.6 
382.5 
617.2 
818.2 . 


3.7 
1.5 
1.5 

2.8 

4.6 

8.8 

38.3 

147.0 

356.2 

625.3 

822.8 


4.0 

1.6 

1.4 

2.8 

3.7 

18.5 

99.3 

238.6 

423.2 

665.1 

863.9 


2.6 

1.0 

.3 

2.2 

1.3 

7.5 

30.0 

84.7 

183.1 

230.5 

384.1 


2.5 

1.0 

.6 

2.9 

6.3 

33.2 

118.1 

238.7 

359.1 

433.4 

580.7 



In the introduction to this present section, we indicated that, in 
general, cancer mortality was lower among colored persons than 
among white persons, and that colored males showed relatively 
more favorable rates than colored females. Without any emphasis 
at this present time upon the organs or parts affected by cancer, 
we may now consider the general age characteristics of this disease. 

A fairly significant rate is registered for the ages one to four 
years in the total experience. The cancer rate declines thereafter 
to its minimum at ten to fourteen years of age and then rises, at 
first gradually, but afterward in heavy increments up to the latest 
age period in this series. The same general characteristics of the 



CANCEE. 



151 



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152 MORTALITY STATISTICS OF INSURED WAGE EARNERS, 

age course of cancer mortality are observed for white males as for 
white females, with the exception that the upward slope of the curve 
for white females is very much sharper for the ages beyond 25 
years. The cancer death rates for colored persons under 25 years 
of age are, for the most part, very low, and fluctuate somewhat 
irregularly. Beginning with the age period 25 to 34 years, how- 
ever, there is a constantly increasing rate, up to the highest age 
period recorded in this series. 

Color Ratio of Cancer Mortality. 

White males show emphatically higher cancer death rates at 
every age period than were recorded for colored males. Compari- 
sons between the cancer death rates of white and colored females 
are practicable beginning with the age period 25 to 34 years. Be- 
tween 25 and 44 years, the cancer death rate of white females 
was decidedly lower than the rate for colored females. Between 
45 and 54 years, the rates were practically the same. Beginning 
with the age period 55 to 64 years and continuing to the highest 
age period in the table, we observe that the cancer death rates of 
white females were much higher than the rates for colored females. 
These differences in the total cancer death rates of white and 
colored females are to be accounted for, as will be shown later, by 
the higher mortality from cancer of the generative organs among 
colored females. 

Sex Ratio of Cancer Mortality. 

We have seen that among white lives the cancer death rate of 
females was practically one and two-thirds that of males. 
Cancer mortality of white males exceeds that of white females only 
for cancer of the buccal cavity, where the rates are 4.6 and .9 per 
100,000 persons exposed, respectively; for cancer of the skin, 
where the rates are 2.2 and 1.6 respectively, and for the group of 
'^ cancers of other organs or of organs not specified." For 
cancer of the stomach and liver and of the peritoneum, intestines 
and rectum, the death rates of white females were decidedly in 
excess of those for white males. In addition, white females showed 
a high death rate for cancer of the female genital organs (25.3 per 
one hundred thousand) and for cancer of the breast (11.7 per one 
hundred thousand). Practically the same general remarks apply 



CANCER. 



153 



to the comparative cancer death rates of colored males and colored 
females when compared with respect to the several organs affected 
by malignant growths. 

There are no important differences in the cancer mortality of the 
two saxes among white lives under 25 years of age. Beginning with 
the age period 25 to 34 years, however, the cancer death rates of 
white females exceed those of white males substantially, up to and 
including the age period 55 to 64 years. Thus at the age period 35 
to 44 years the rate for white males was only 38.6 per cent, of that 
for white females. After age 65, the disproportion between the 
rates for the two sexes among white lives is not so great. 

The excess of the cancer death rate of colored females over the 
rate for colored males is much greater than was observed, age 
period by age period, for white lives. Thus between 25 and 45, 
the rate for colored males was only about one-fourth as great as 
for colored females. In the following table, we give, first, a 
statement of the ratio of cancer mortality between the two races 
and, second, the sex ratio according to age period : 



TABLE 89 

MORTALITT FROM CaNCEH (AlL FOEMS). 

Percentages: Colored of White Mortality hy Sex; Male of Female Mortality 

iy Color; Classified hy Age Period. 1911 to 1916. 

Experience of Metropolitan Life Insurance Company. Industrial 

Department. 





Per Cent. Colored of White 
Mortality. 


Per Cent. Male of Female 
Mortality. 




Males. 


Females. 


WWte. 


Colored. 


All Ages — One and 
Over 


61.5 


99.3 


57.0 


35.3 






1 to 4 

5 to 9 

10 to 14 

15 to 19 

20 to 24 

Ages 25 and Over 


70.3 
66.7 
20.0 

78.6 
28.3 

43.0 


62.5 

62.5 

42.9 

103.6 

170.3 

80.1 


92.5 

93.8 

107.1 

100.0 

124.3 

70.5 


* 
* 
* 
* 
* 

37.9 


25 to 34 

35 to 44 

45 to 54 

55 to 64 

65 to 74 

75 and over. . . . 


85.2 
78.3 
57.6 
51.4 
36.9 
46.7 


179.5 

118.9 

100.0 

84.9 

65.2 

67.2 


47.6 
38.6 
61.6 

84.2 
94.2 
95.2 


22.6 
25.4 
35.5 
51.0 
53.2 
66.1 



* Insufadent data. 



164 



MORTALITY STATISTICS OF INSURED WAGE EARNERS. 



Compari'Son of Cancer Death Rates among Insured Wage Earners 

with Rates for Population of Expanding Registration Area 

of the United States. 

For both males and females, at all ages one and over combined, 
tlie cancer death rates of white lives in the insurance experience are 
substantially lower than the rates recorded in the Registration Area 
of the United States. This favorable ratio for the cancer mortality 
experience of insured wage earners does not hold for all of the 
age periods. Thus, the cancer death rate among white male wage 
earners is, in general, lower than the rate for males in the general 
population only at ages under 35 years. Among white insured 
females, the cancer death rate is lower than the rate among females 
in the general population only between 20 and 35 years of age. 

The cancer death rate among both white males and white females 
of the insurance experience is higher than the rate for males and 
females in the Registration Area at every age period beyond 35 
years of age, where cancer is of the most importance as a cause of 
death. It should be remarked also that male wage earners show 
much greater percentages of excess in cancer mortality than do 
females in wage earners' families. The following table sets forth 
these comparative facts of cancer mortality: 

TABLE 90. 
Mortality from Cancer (All Forms). 
Death Bates per 100,000 Persons Exposed. Classified hy Sex and by Age 
Period. Insured White Lives in "Experience of Metropolitan Life In- 
surance Company, Industrial Department (1911 to 1916) and 
General Population Experience of Expanding Registra- 
tion Area of the United States {1910 to 1915). 





Males. 


Females. 


Age Period. 


M. L. 1. Co. 

(White). 


V. S. Reg. 
Area. 


Per Cent. 
M.L.I. Co. 
ol Reg .Area. 


M. L. I. Co. 
(White). 


U. S. Reg. 
Area. 


Percent. 
M. L. I. Co. 
ot Reg. Area. 


AH ages — one 
and over 


50.4 


62.2 


81.0 


88.4 


97.9 


90.3 


1 to4.... 


3.7 


3.6 


102.8 


4.0 


3.1 


129.0 


5 to 9.... 


1.5 


2.0 


75.0 


1.6 


1.4 


114.3 


10 to 14... 


1.5 


1.7 


88.2 


1.4 


1.4 


100.0 


15 to 19... 


2.8 


2.9 


96.6 


2.8 


2.6 


107.7 


20 to 24... 


4.6 


4.4 


104.5 


3.7 


4.6 


80.4 


25 to 34... 


8.8 


9.3 


94.6 


18.5 


20.8 


88.9 


35 to 44... 


38.3 


31.9 


120.1 


99.3 


89.0 


111.6 


45 to 54... 


147.0 


109.8 


133.9 


238.6 


227.0 


105.1 


55 to 64... 


356.2 


280.3 


127.1 


423.2 


406.9 


104.0 


65 to 74... 


625.3 


503.4 


124.2 


665.1 


607.0 


109.6 


75 and ovei 


• 822.8 


710.2 


115.9 


863.9 


828.2 


104.3 



CANCEE. 



165 



Relation of Cancer to Economic Condition or Social Statits. 

At this point in the discussion, brief reference may be made to 
the possible relation between the incidence of cancer mortality and 
economic status, as indicated in a paper recently published on this 
subject.* The following table shows the main facts of an in- 
vestigation based upon the comparative mortality experience of the 
Ordinary, Intermediate and Industrial Departments of the Metro- 
politan Life Insurance Company during the three years 1914, 1915, 
and 1916, White lives only were included in this investigation. 
The Ordinary Department policyholders are drawn from higher 
economic strata of the population than are the "Intermediate" 
group. The Industrial policyholders form the third class or group 
in order of material circumstance. In order to eliminate the 
slight effect of medical selection in the Ordinary and Intermedi- 
ate groups with respect to cancer, we considered only the mortal- 
ity in these classes on business in force at least five years. 



TABLE 91. 

Cancer Claim Bates per Hundred Thousand Mean in Force, 

Ordinary and Intermediate Departments, First Five Years of Issue Excluded 

Compared with Industrial Department, All Years of Issue Combined. 

Composite Mortality Experience 1914, 1915, and 1916. White 

Lives. By Sex a/nd hy Age Period. 



Sex and Age Period. 


Ordinary De- 
partment. 


Intermediate 
Branch. 


Industrial De- 
partment. 


Males: 
Ages 25 and over 


83.5 


70.3 


140.0 






25 to 34 


12.0 

33.4 

104.3 

276.5 

662.5 


8.7 

41.8 

107.6 

295.1 

645.3 


9.7 


35 to 44 


37.5 


45 to 54 


154.1 


55 to 64 


368.0 


65 and over 


679.2 






Females: 

Ages 25 and over 


141.6 


115.1 


197.7 






25 to 34 


31.4 

71.6 

213.5 

353.6 

313.1 


25.4 

87.8 

206.7 

422.1 

1,009.8 


17.8 


35 to 44 


98.9 


45 to 54 


235.8 


55 to 64 


429.6 


65 and over 


707.5 



* Knight, Augustus S., and Dublin, Louis I., "The Eelation of Cancer 
to Economic Condition." Eead before the Association of Life Insurance 
Medical Dibectors of America, Worcester, Mass., October 17, 1917, Re- 
printed by Metropolitan Life Insurance Company, New York, 1917, 



156 MOKTALITT STATISTICS OF INSURED WAGE EARNERS. 

In this table, clwlm rates per one hundred thousand mean in-force 
for the several departments are compared. Actual experience 
demonstrates that very little error is involved in a comparison of 
mortality rates based upon the number of claims reported and the 
mean number of policies in-force if such data are related strictly 
to age periods. The comparison is valid therefore as above given. 
Because of the heavy representation of policyholders at the ages 
under 45 years, with a small num*ber -of deaths, leading to aberrant 
cancer death rates for these ages, the Intermediate rates for both 
males and females at all ages are apparently the lowest. At the 
ages beyond 45 years, where* cancer mortality is numerically signi- 
ficant, the Industrial group showed the highest rate, the Ordinary 
the least and the Intermediate a rate between the other two. As a 
result of an extended consideration of the data developed in this 
inquiry into the possible relation of cancer and economic condition, 
it was concluded that: 

1. The current medical opinion that there is strong association 

between low economic status and a low cancer death rate is 
in all probability unfounded. 

2. The cancer mortality rate at the ages where the cancer rate is 

significant, decreases as we go up in the economic scale. 

3. This is shown to be true for each sex where sufficient data are 

available. 

4. This conclusion is not conditioned by the effect of varying 

amounts of medical selection in the three groups considered. 

Trend of the Cancer Death Bate. 

Medical literature of the past few years contains much contro- 
versy on the question whether mortality from cancer is actually 
increasing or not. One school of research holds "that the mor- 
tality from cancer is increasing at a more or less alarming rate 
throughout the entire civilized world and that this increase implies 
most serious consequences, present and future, to the populations 
concerned."* Another group of statisticians holds that "the re- 
ported mortality from cancer is increasing in almost every part of 
the world, but the real mortality, if increasing at all, is certainly 
not increasing with equal rapidity. . . . The cumulative evidence 

* Hoffman, Frederick L., ' ' The Mortality from Cancer Throughout the 
World," p. 218. Prudential Press, Newark, New Jersey, 1915. 



CANCEK. 



157 



that improvements in diagnosis and changes in age composition 
explain away more than half and perhaps all of the apparent in- 
crease in cancer mortality rebuts the presumption raised by the 
figures and makes it probable, though far from certain, that cancer 
mortality is not inereasing."f 

It is not the purpose of this section to take sides in the contro- 
versy. It is desired to offer the mortality records of the present 
investigation only as a contribution to the available supply of 
trustworthy data on the trend of cancer mortality. The following 
table shows the rates per 100,000 persons exposed in each of the 
color and sex classes within the scope of this inquiry for the years 
1911 to 1916: 

TABLE 92. 

Mortality from Cancer, All Forms, Classified by Color and by Sex. 
Death Bates per 100,000 Persons Exposed. Single Years in Period 1911 

to 1916. 

Experience of Metropolitan Life Insurance Company. Industrial 
Department. 





Persons. 


wmte. 


Colored. 


Year. 


Males. 


Females. 


Males. 


Females. 


1911 to 1916 


70.0 


50.4 


88.4 


31.0 


87.8 


1916 

1915 

1914 

1913 

1912 

1911 


70.3 
70.9 
69.8 
70.5 
70.3 
68.0 


51.8 
50.7 
50.7 
51.4 
47.8 
49.6 


87.2 
89.8 
87.9 
87.5 
91.7 
86.5 


36.5 
29.0 
28.0 
32.4 
30.7 
28.9 


86.1 
90.4 
88.3 
93.6 
86.3 
81.3 



Cancer death rates in this present experience, covering six 
calendar years, and relating in all to fifty million years of life ex- 
posed to risk, show no decisive upward or downward tendency for 
all age classes com'bined. This is true for each color and sex group- 
but more decisively for the group of insured white females for 
whom the highest rates are recorded. The rates, by color and by 
sex, for the year 1911 are, to be sure, slightly lower than the fig- 
ures for the entire six year period; this condition may be acci- 
dental and without significance. Considering all ages combined, 
therefore, there is no evidence presented in these figures from 

+ Willcox, Walter F., "On the Alleged Increase of Cancer, ' ' Quarterly 
Publications of the American Statistical Association, Sept., 1917, p. 756. 



158 MORTALITY STATISTICS OF INSURED WAGE EARNERS. 

which an increasing mortality may be predicated with any 
certainty. 

It would be more significant perhaps in this discussion to con- 
sider the trend of the cancer death rate during the six year period 
in a definite age period, especially one in which the cancer death 
rate is usually high. For this purpose we have chosen the age 
period 55 to 64 years. The following table shows for each one of 
the color and sex groups, the death rates from cancer (all forms) 
during the six year period: 

TABLE 93. 

Mortality from Cancer (All Forms) Ages 55 to 64 Tears, Classified 

BY Color and by Sex. 
Death Bates per 100,000 Persons Exposed. Single Years in Period 1911 

to 1916. 

Experience of Metropolitan Life Insurance Company. Industrial 

Department. 





Persona. 


WWte. 


Colored. 


Year. 


Males. 


Females. 


Males. 


Females. 


1916 

1915 

1914 

1913 

1912 

1911 


386.4 

380.8 
390.9 
384.1 
381.9 
368.7 


358.0 
336.0 
385.0 
370.3 
334.1 
353.3 


427.4 
427.8 
423.3 
414.6 
443.2 
400.2 


218.3 
175.7 
167.7 
195.2 
176.4 
158.0 


339.9 
394.3 
351.7 
368.3 
325.4 
373.7 



This table shows very much the same trend situation in the age 
period 55 to 64 years as we found for all ages combined. The year 
1911 was again a year of comparatively low cancer mortality. As 
the figures are compared for the individual years we find some 
variation with no clearly defined tendency toward increase or de- 
crease. Our data, therefore, need not serve to confirm either one 
of the two opposing opinions and, in fact, point out the necessity 
for reserve and caution in predicating any decisive opinion with 
regard to the real trend of cancer mortality during recent years. A 
longer period of time will be required to collect authentic figures 
upon which a definite Judgment can be based. Considerable 
analysis of cancer data according to age, sex, color and organ or 
part affected will be necessary before any final conclusions can be 
drawn as to the amount of increase, if any, in recent years. An- 



canceIr. 



159 



other view of our data with respect to this question of cancer 
mortality increase is presented in the following table: 

TABLE 94. 

Mortality from Cancer (All Forms). 

Percentage, Death Rate per 100,000 Persons Exposed in 1915-1916 of Death 

Rate in 1911-1912. Classified hy Color, Sex and by 

Significant Age Periods. 

Experience of Metropolitan Life Insurance Company. Industrial 
Department. 





Persons. 


White. 


Colored. 


Age Period. 


Males. 


Females. 


Males. 


Females. 


Ages 25 and over . . 


101.0 


105.2 


98.3 


105.1 


100.7 


25 to 34 

35 to 44 

45 to 54 

55 to 64 

65 to 74 

75 and over. . 


98.1 
100.1 

99.1 
102.2 
107.0 
101.0 


121.0 
104.3 
109.7 
101.1 
115.9 
104.1 


94.1 

96.9 

97.0 

101.2 

101.9 

104.4 


95.5 
142.6 

67.7 
118.0 
117.2 
110.7 


95.0 
98.2 
93.1 
105.2 
107.0 
48.6 



We have eliminated in this table any superfluous references to 
ages under 25 years and in order to get at the heart of the matter 
have presented only the percentage which the cancer death rate in 
two years combined, 1915-1916, was of the death rate in two 
prior years, 1911-1912, at each significant age period, for each 
color and sex class. 

Considering all persons in this mortality experience at ages 25 
and over, there was an increase of only 1.0 per cent, in the cancer 
death rate between the two periods compared. This figure is a 
composite of a variously weighted increase of 5.2 per cent, for white 
males, a decrease of 1.7 per cent, for white females, an increase of 
5.1 per cent, for colored males and a practically stationary rate for 
colored females. Considered according to age period, this in- 
crease of 1.0 per cent, in the cancer death rate of all persons in 
this experience, aged 25 years and over, was a composite of a de- 
crease of 1.9 per cent, between 25 and 34 years, contributed very 
largely out of the experience of white and colored females, a prac- 
tically stationary death rate between 35 and 44 years, which is, in 
itself, a composite of an increase for white and colored males and 
a decrease for white and colored females, and a slight decrease 
between 45 and 54 years. At this latter age period, we observe an 



160 MOETALITY STATISTICS OF INSUEED WAGE EARNERS. 

increase of nearly ten per cent, in the white male rate, a decrease 
of 3.0 per cent, for white females, of 6.9 for colored females, and 
of 32.3 per cent, for colored males. The major influence, however, 
in slightly lowering the cancer death rate of all persons between 
45 and 54 years was, of course, the experience of the group of 
white females. Between 55 and 64 years, all classes in the mor- 
tality experience show an increase in the rate, highest for colored 
males and least for white males. The age period 65 to 74 years 
shows an increase of 7.0 per cent, which is contributed very largely 
by the experience on male lives of each color group. It should 
be remarked that the cancer experience of colored persons exerts 
but slight influnce upon the ratio of increase of cancer mortality 
in the entire experience. In fact, for some of the age periods, the 
data on the increase of cancer mortality among colored persons are 
aberrant. 

It will be seen from the foregoing table that considerable analysis 
of cancer facts according to age, sex, color and by organ or part 
affected is necessary before any final conclusions are drawn as to 
the amount of real increase in cancer mortality, if any, in recent 
years. A discussion, in some detail, of the cancer mortality ex- 
perience according to the organs or parts follows. 

Cancbe* of the Stomach and Liver. 

The deaths classified under this heading constituted, as was 
shown above, the most important subordinate group of specific 
types of cancer. Cancers of the stomach and liver were recorded in 
37.6 per cent, of all cancers in this entire experience. It should 
be remembered that this heading also includes cancers and other 
malignant tumors of the pharynx, the esophagus, and the gall 
bladder, f The combined total of malignant growths of the pharynx 
and esophagus, however, numbers less than five per cent, of all 
deaths recorded under this heading in general practice, and does 
not, therefore, seriously affect the present data. In gall bladder 
cancers the liver is frequently involved. 

We recorded 14,153 deaths from malignant growths of the 
stomach and liver. The death rate was 36.3 per 100,000 persons 

* Cancer and other malignant tumors. 

t The International list heading ' ' Cancer of the Stomach, Liver, ' ' is 
somewhat misleading, inasmuch as cancers of certain other organs of the 
digestive system are classified under it, as noted above. 



CANCEE. 



161 



exposed. As shown in the following table, the facts vary con- 
siderably according to color, sex and age period. 



TABLE 95. 

Mortality from Cancer of the Stomach and Liver, Classified by Color, 
Sex and by Age Period. 

Death Bates per 100,000 Persons Exposed. 1911 to 1916. 

Experience of Metropolitan Life Insurance Company. Industrial 
Department. 





Persona. 


White. 


Colored. 


Age Period. 


Males. 


Females. 


Males. 


Females. 


AU ages — one and 
over 


26.3 


24.8 


29.8 


16.2 


18.5 






lto24 

25 to 34 

35 to 44 

45 to 54 

55 to 64 

65 to 74 

75 and over. . 


.3 
3.0 

18.6 

67.2 

168.5 

276.0 

334.7 


.3 

2.9 

18.1 

77.0 

193.3 

303.6 

339.1 


.3 

2.7 

20.1 

67.7 

168.4 

288.7 

353.3 


.2 

3.3 

13.8 

44.0 

108.0 

125.3 

164.6 


.6 
5.0 

16.5 

44.8 

99.5 

122.1 

217.8 



There is a higher death rate for this cause, without important 
exception, for white lives than for colored lives. Below 35 
years, mortality from cancer of the stomach and liver is not numer- 
ically important. The death rate increases from a figure of 18,6 
in the age period 35 to 44 years to the maximum in the highest 
age period in this series, 75 years and over. From 45 years ol 
age and onward, however, the death rate of white males for this 
disease is appreciably higher than the rate for white females, with 
the exception of the very highest age period, 75 years and over. 
Among colored persons the death rate from cancer of the stomach 
and liver is higher for males than for females between 55 and 74 
years only. At the ages under 55 years, colored females show 
higher death rates from this cause than do colored males. 

Comparison of Data for Cancer of the Stomach and Liver among 

Insured Wage Earners and among the Population of the 

Expanding Registration Area of the United States. 

For both males and females at the ages where death rates from 
this cause are at all significant, a higher death rate is recorded 

12 



162 



MORTALITY STATISTICS OF INSUEED WAGE EAENERS. 



among the group of insured wage earners than is observed in the 
Eegistration Area of the United States. Beginning with the age 
period 35 to 44 years, there is an excess of over nineteen per cent., 
between 45 and 54 years, an excess of thirty-two per cent., and 
between 55 and 64 years, an excess of twenty-nine per cent, over 
the rates for males prevailing in the expanding Eegistration Area 
of the United States. The excess in the death rate of cancer of 
the stomach among insured females is not so great as in the case 
of insured males. In the following table, a comparison of the 
foregoing facts is given: 



TABLE 96. 

Mortality from Cancer of the Stomach and Liver. 

Death Bates per 100,000 Persons Exposed, Classified by Sex and hy Age 
Period. Insured White Lives in Experience of Metropolitan Life 
Insurance Company, Industrial Department (1911 to 1916) 
and General Population Experience of Expanding Eegis- 
tration Area of the United States {1910 to 1915). 





"" 


Males. 


Females. 


Age Period. 


M.L.I. Co. 
(White). 


U. S. Reg. 
Area. 


Per Cent. 
M.L.I. Co. 
of Reg. Area. 


M.L.I. Co. 

(Wlilte). 


gU. S. Reg. 
Area. 


Per Cent. 
M.L.I. Co. 
<rf Reg. Area. 


All ages — one 
and over 


24.8 


30.5 


81.3 


29.8 


32.1 


92.8 


Under 25... 
25 and over. 


.3 

65.8 


.4 
56.4 


75.0 
116.7 


.3 
63.0 


.3 
61.4 


100.0 
102.6 


25 to 34.. 
35 to 44. . 
45 to 54.. 
55 to 64.. 
65 to 74.. 
75 and ove 


r. 


2.9 

18.1 

77.0 

193.3 

303.6 

339.1 


3.0 

15.2 

58.4 

150.2 

254.3 

294.1 


96.7 
119.1 
131.8 
128.7 
119.4 
115.3 


2.7 

20.1 

67.7 

168.4 

288.7 

353.3 


3.9 

18.2 

62.1 

147.5 

253.6 

313.7 


69.2 
110.4 
109.0 
114.2 
113.8 
112.6 



Trend of the Death Rate from Cancer of the Stomach and Liver. 

Not much stress can be put on the figures showing the trend of 
the death rate in the period between 1911 and 1916. In the first 
place, the figures vary considerably from year to year, sometimes 
increasing, sometimes decreasing; also, cancer of the stomach and 
liver affects organs which are practically inaccessible for purposes 
of precise diagnosis. There must, therefore, be considerable uncer- 



CANCER. 



163 



tainty in the degree of precision of the diagnosis. It will be neces- 
sary, therefore, to wait for an extension in the period of observa- 
tion before any definite tendency of the death rate from this form 
of cancer can be predicated. In the meanwhile as diagnostic facili- 
ties become more generally available and as the practice of making 
autopsies 'becomes more widespread it may be expected that the 
recorded death rates for cancer of the stomach and liver will show 
slight increases. 

Cancer* op the Female Genital Organs. 

Cancer of the female genital organs accounted for 28.6 per cent, 
of all cancer deaths among white females. The very largest pro- 
portion of these cancers affected the uterus, with the ovaries and 
Fallopian tubes next in numerical importance. 

TABLE 97. 

Mortality from Cancer of the Female Genital Organs, Classified by 
Color and by Age Period. 

Death Bates per 100,000 Persons Exposed. 1911 to 1916. 

Experience of Metropolitan Life Insurance Company. Industrial 
Department. 



Age Period. 


White Femalea. 


Colored Females. 


A.11 ages — one and over. 


25.3 


37.9 


1 to 19 


.2 

1.0 

7.9 

43.4 

85.7 

109.4 

110.3 

93.8 


.2 


20 to 24 


1.3 


25 to 34 


17.7 


35 to 44 


62.9 


45 to 54 


109.7 


55 to 64 


131.6 


65 to 74 


131.5 


75 and over 


145.2 



In all, 7,882 deaths from cancer of the female genital organs 
were recorded in the six year period of this study. The rate has 
significance only when the deaths are related to the number of 
females exposed. The 6,499 cancers registered among white 
females corresponded to a rate of 25.3 per 100,000 such females 
exposed and the 1,383 deaths among coPlored females to a rate of 
37.9 per 100,000 exposed. Under the age of 25 years, there was 

* Cancer and other malignant tumors. 



164 



MOETALITY STATISTICS OF INSURED WAGE EAENEES. 



no significant mortality from this cause. Beginning with the age 
period 25 to 34 years, however, there was a quite considerable rate 
of mortality, 7.9 per 100,000 for white females and 17.7 for colored 
females. This excess in the mortality rate from cancer of the 
female genital organs among colored females is decidedly marked 
at all of the age periods in this series. The maximum rates of 
mortality from this cause appear at the older ages. The foregoing 
table gives the facts according to age classes among white and 
colored females. 

Compa/rison of Death Rates from Cancer of the Female Genital 

Organs in Insurance Experience on White Lives and in 

Experience of the Population of the Expanding 

Registration Area. 

It is found that white females in wage earners' families show 
a decided excess in the mortality rate from cancer of the female 
genital organs over the rates recorded for females in the general 
population of the expanding Eegistration Area. The following 
table gives a comparative view of these death rates: 



TABLE 98. 

Mortality from Cancer of the FEmale Genital Organs. 

Death Bates per 100,000 Persons Exposed. Classified hy Age Period. In- 
sured White Females in Experience of Metropolitan Life Insurance 
Company, Industrial Department (1911 to 1916) and Females 
in General Population Experience of Expanding Eegis- 
tration Area of the United States (1910 to 1915). 





Females. 


Age Period. 


M. L. I. Co. 
(White). 


U. S. Reg, Area. 


Per Cent. M.L. 
I. Co. of Regis- 
tration Area. 


All ages — one and over 


25.3 


25.0 


101.2 






Under 25 


.4 
53.2 


.5 

47.7 


80.0 


25 and over 


111.5 






25 to 34 


7.9 

43.4 

85.7 

109.4 

110.3 

93.8 


8.4 
34.7 
75.6 
99.9 
103.2 
98.3 


94.0 


35 to 44 


125.1 


45 to 54 


113.4 


55 to 64 


109.5 


65 to 74 


106.9 


75 and over 


95.4 



CANCEK. 



166 



The greatest excess in mortality from cancer of the female 
genital organs among white females in the families of insured wage 
earners was recorded between 35 and 44 years. The percentage 
of excess in mortality from this cause among white females de- 
creases with advancing age, and at the very late ages in life the 
rates for both the insurance and population experience tend to 
approximate each other. 

Trend of the Death Rate from Cancer of the Female Genital 

Organs. 

The figures available show neither a favorable nor unfavorable 
tendency of the death rate from cancer of the female genital organs. 
There are slight variations from year to year. 

Cancer* of the Beeast. 

TABLE 99. 

Mortality from Cancer of the Breast. 

Number and Percentage of Total Deaths from Cancer of the Breast in Each 
Color and Sex Class. 

Experience of Metropolitan Life Insurance Company. Industrial Depart- 
ment. 1911 to 1916. 



Color and Sex. 


Number of Deaths. 


Per Cent. 


All classes 


3,579 


100.0 






White males 


31 

3,004 

9 

535 


.9 


White females 


83.9 


Colored males 


.3 


Colored females 


14.9 



In view of this very small number of male deaths from cancer 
of the breast, we shall concentrate our attention entirely upon the 
statistics for white and colored females. The following table gives 
the death rates for white females and colored females at the several 
age periods. 

* Cancer and other malignant tumors. 



166 



MORTALITY STATISTICS OF INSURED WAGE EARNERS. 



TABLE 100. 

Mortality from Cancer of the Breast: Females Classified by Color 
AND BY Age Period. 

BeatTi Bates per 100,000 Persons Exposed. 1911 to 1916. 

Experience of Metropolitan Life Insurance Company. Industrial 
Department. 



Age Period. 


White Females. 


Colored Females. 


All ages — one and over 


11.7 


14.7 






1 to 24 


t 

2.5 
17.4 
36.9 
47.6 
76.0 
108.8 


.1 


25 to 34 


3.3 


35 to 44 


18.9 


45 to 54 


41.9 


55 to 64 


59.9 


65 to 74 


96.3 


75 and over 


118.0 







t Less than .05 per 100,000. 



There is a constantly rising death rate with age from this cause 
for both white and colored females. There is also a decided excess 
in the death rate among colored over white females although this 
excess among colored females is not so marked as it was for cancer 
of the female genital organs. 

Throughout the six years under examination, there was, with 
the exception of the year 1915 for colored women, little devia- 
tion in the death rate for cancer of the breast. In the following 
table, we quote our experience for each of the years from 1911 to 
1916: 

TABLE 101. 

Mortality from Cancer of the Breast. Females Classified by Color. 
Death Bates per 100,000 Persons Exposed. Single Years in Period 1911 

to 1916. 

Experience of Metropolitan Life Insurance Company. Industrial 
Department. 



Years. 


White Females. 


Colored Females. 


1911 to 1916 


11.7 


14.7 






1916 


11.8 
12.5 
11.4 
11.9 
12.1 
10.2 


14.9 


1915 


17.4 


1914 


12.3 


1913 


14.3 


1912 


15.6 


1911 


13.5 









CANCER. 



167 



Cancer of the breast seems not to have as heavy a mortality 
among vrhite insured females as it does among females in the 
population of the expanding Eegistration Area of the United 
States. Between 35 and 44 years, there is practically the same 
death rate from this cause in each experience. But, between 55 
and 64 years, the group of insured females in wage earners' fami- 
lies shows much lower death rates from this cause than were found 
for females in the Eegistration Area of the United States. It 
should be recalled at this point that the data for the expanding 
Eegistration Area comprise a small proportion of colored women. 
This fact, on account of the higher death rate from cancer of the 
breast among negro women than among white women, may account 
in some measure for the higher mortality from this cause in the 
population experience over the exclusively white insurance experi- 
ence. The following table affords a comparative view of the sta- 
tistics for cancer of the breast among insured white females and 
among females in the general population of the expanding Eegis- 
tration Area: 

TABLE 102. 
Mortality 'fejou Cancer op the Breast. 

Death Rates per 100,000 Persons Exposed. Classified hy Age Period. In- 
sured White Females in Experience of Metropolitan Life Insurance 
Company, Industrial Department (1911 to 1916) and Females 
in General Population Experience of Expanding Regis- 
tration Area of the United States (1910 to 1915). 



Age Period. 


M. L. I. Co. 
(WUte). 


U. S. Reg. 
Area. 


Per Cent. 

M. L.I. Co. 

of Registration 

Area. 


All SiS,Q8 one and over 


11.7 


15.5 


75.5 






Under 25 


t 
24.7 


.1 

29.7 





25 and over 


83.2 






25 to 34 


2.5 
17.4 
36.9 
47.6 
76.0 
108.8 


2.7 
17.5 
41.3 
61.0 
81.0 
130.6 


92.6 


35 to 44 


99.4 


45 to 54 


89.3 


55 to 64 


78.0 


65 to 74 


93.8 


75 and over 


83.3 



t Less than .05 per 100,000. 



168 



MOETALITT STATISTICS OF INSURED WAGE EAENERS. 



Cancer* of the Peritoneum, Intestines and Eectum. 

Cancer of the intestines constituted the very largest number of 
the 4,483 deaths under this head. The death rates by age, sex 
and color for this cause are shown below: 



TABLE 103. 

Mortality from Cancer of the Peritoneum, Intestines and Rectum. 
Classified by Color, Sex and by Age Period. 

Death Bates per 100,000 Persons Exposed. 1911 to 1916. 

Experience of Metropolitan Life Insurance Company. Industrial 
Department. 





Persons. 


White. 


Colored. 


Age Period. 


Males. 


Females. 


Males. 


Females. 


All ages — one and 
over 


8.3 


6.6 


10.5 


3.4 


7.2 






1 to24.... 
25 to 34 ... . 
35 to 44 ... . 
45 to 54 ... . 
55 to 64 ... . 
65 to 74 ... . 
75 and over. 


.4 

2.2 

7.8 

22.1 

43.9 

83.1 

109.5 


.4 
1.6 
6.0 
19.7 
43.6 
80.8 
86.5 


.3 
2.2 

8.8 

25.8 

50.5 

95.0 

130.6 


.2 

1.8 

4.0 

7.5 

13.2 

28.4 

96.0 


,3 
3.9 
11.7 
19.9 
21.1 
31.7 
36.3 



Mortality from this form of cancer also increases with advanc- 
ing age. White males show lower death rates at all significant 
ages than do white females. The colored male death rate from 
this cause is also decidedly lower than the rate for colored females. 
It would be well to recall at this present time that in this investiga- 
tion tuberculous disease of the abdominal organs also shows a 
higher death rate among females of both white and colored races, 
especially at the ages of the childbearing period, 15 to 45 years. 
This fact suggests the possible influence of puerperal traumata as 
contributing causes in exciting both tuberculous and cancerous 
processes in the main adult ages among females. 

At the ages in which the death rate from cancer of the peri- 
toneum, intestines and rectum is considerable, insured white males 
show higher rates than do males in the general population. Be- 
tween 45 and 75 years of age, the excesses in the rates range from 

* Cancer and other malignant tumors. 



CANCEE. 



169 



16 to 30 per cent. Insured white females, on the other hand, 
show no very marked tendency to depart from the general popula- 
tion experience. At some age periods, the death rate among in- 
sured white females is slightly more favorable and at other age 
periods slightly less favorable than among females in the general 
population. The following table gives a comparative view of the 
data for males and females of the insurance and population experi- 
ence, considered according to age period: 

TABLE 104. 
Mortality from Cancer of the Peritoneum, Intestines and Rectum. 

Death Bates per 100,000 Persons Exposed. Classified iy Sex and hy Age 
Period. Insured White Lives in Experience of Metropolitan Life In- 
surance Compamy, Industrial Department (1911 to 1916) and 
General Population Experience of Expanding Registra- 
tion Area of the United States {1910 to 1915). 





Males. 


Femalea. 


Age Period. 


M.L.I. Co. 
(White). 


U. S. Reg. 
Area. 


Per Cent. 
M.L.I. Co. 
of Reg. Area. 


M.L.I. Co. 
(White). 


U. S. Reg. 
Area. 


Per Cent. 
M.L.I. Co. 
of Reg. Area. 


All ages — one 
and over 


6.6 


8.6 


76.7 


10.5 


10.4 


101.0 


Under 25... 
25 and over. 


.4 
16.9 


.5 
15.5 


80.0 
109.0 


.3 

21.9 


.3 
23.5 


100.0 
93.2 


25 to 34.... 
35 to 44.... 
45 to 54.... 
55 to 64.... 
65 to 74.... 
75 and over. 


1.6 
6.0 
19.7 
43.6 
80.8 
86.5 


2.1 
5.5 
15.2 
37.6 
67.6 
80.9 


76.2 
109.1 
129.6 
116.0 
119.5 
106.9 


2.2 

8.8 

25.8 

50.5 

95.0 

130.6 


2.6 

9.1 

24.6 

51.8 

89.5 

117.6 


84.6 

96.7 

104.9 

97.5 

106.1 

111.1 



The data indicate a practically stationary death rate from this 
cause between 1911 and 1916. 



Other Foems of Cancee.* 

Discussion in great detail of cancers of organs and parts of the 
body, in addition to those covered by the preceding text, is not 
justified for many reasons. There are, however, many interesting 
and important age, sex, and color relations disclosed in the study 
of " other cancers " which should not be passed without brief com- 
ment. These we shall discuss briefly in relation to cancers of the 

* Cancer and other malignant tumors. 



170 MOETALITY STATISTICS OF INSURED WAGE EAENEES. 

buccal cavity, of the skin, and of all "other organs or of organs 
not specified" in the order named. 

Cancer* of the Buccal Cavity. 

Cancer of the buccal cavity, including cancer of the maxillae, 
caused 1,353 deaths during the six year period 1911 to 1916. This 
corresponds to a death rate of 2.5 per 100,000 exposed. Of the 
1,353 deaths, 1,229 were those of white policyholders and 124 of 
colored persons. The death rate per 100,000 exposed was 2.6 for 
white lives as compared with 1.9 for colored lives. Cancer of the 
buccal cavity shows a very strong sex incidence. Of the 1,353 
deaths, 1,064 were those of males and only 289 those of females. 
This excess among males applies to both white and colored lives; 
especially to the former, among whom male mortality (4.6) was 
more than five times that of females (.9). White males show a 
death rate almost twice that for colored males (4.6 as compared 
with 2.5). In the female experience the rate for colored women 
(1.3) exceeds that for insured white women (.9). This compari- 
son for colored policyholders, however, is hardly valid on account 
of the small number of deaths involved. 

The great majority of the deaths classified as due to cancer of 
the buccal cavity were reported under the terms "cancer of the 
jaw," " cancer of the tongue," " cancer of the lip," and " cancer of 
the mouth" without more definite designation. 

There is no pronounced upward or downward trend shown for 
cancer of the buccal cavity in the Industrial experience of this 
Company during the six year period covered by this report. The 
death rate was 2.3 per 100,000 exposed in the first year of the 
sexennium as compared with 2.4 for the last year. The rates in 
the general population are slightly higher than those for the in- 
sured. This is accounted for largely by differences in the age 
distribution of the two populations. As a general proposition only 
5 per cent, of the deaths from this disease occur among persons 
under 50 years of age. The great bulk of the deaths are those of 
men between the ages of 50 and 79. 

Cancer* of the Skin. 
Skin cancers were reported as causes of death in 938 cases in 
the mortality experience of insured wage earners covering the six 

* Cancer and other malignant tumors. 



CANCEE. 171 

year period 1911 to 1916, corresponding to a death rate of 1.7 per 
100,000 exposed. Little fluctuation is shown in the rate when the 
years of the period are compared with one another. Cancer of the 
skin is, almost altogether, confined to white persons. In the 
Metropolitan experience 887 of the 938 deaths were those of white 
persons, the total white death rate being 1.9 per 100,000 exposed as 
compared with .8 for the colored insured. In the matter of sex 
incidence a considerable excess in the white experience is shown 
for males over females; the rate for the former being 2.2 as com- 
pared with 1.6 for the latter. The rates for colored policyholders 
are not so significant when compared by sex on account of the 
small number of deaths involved. 

As with cancers of the buccal cavity, only a comparatively small 
percentum of the deaths from skin cancers are those of persons 
under 50 years of age. The mortality is bulked between the ages 
of 60 and 79 years. When we compare buccal.and skin cancers by 
age groups we find that there is a much higher mortality, rela- 
tively, from the skin cancers in extreme old age than from cancers 
of the buccal cavity. 

A lower death rate at all ages for this form of cancer is found 
among the insured than among the general population. The same 
explanation for this obtains as for cancer of the buccal cavity, 
namely, the lower average age of the group of policyholders. 
Like that of the insured group, the general population experience 
for this cause of death shows little change in the rate during the 
sexennium to which this report relates. The great majority of the 
deaths charged to this title heading were reported in one of the 
following ways : cancer of the face, cancer of the nose, cancer of the 
skin, rodent ulcer, and epithelioma (location not indicated) . 

Cancer and Other Malignant Tumors of Other Organs or of 
Organs not Specified. 

The above is a residual heading under which are classified all 
deaths from cancers that cannot be definitely assigned to one of 
the preceding titles ; it also includes cancers in which no statement 
is given of the location or original seat of the disease. The more 
definite titles included are the cancers of the bladder, of the pros- 
tate, of the pancreas, of the kidney and suprarenals, of the lung 



172 MORTALITY STATISTICS OF INSURED WAGE EARNERS. 

and pleura, of the bones (jaw excepted), of the larynx, of the 
brain, of the testes, of the parotid gland, and of the spleen. 

This title constitutes an important cause of death numerically 
in the present experience. No fewer than 5,279 deaths were 
charged to it and the corresponding rate was 9.8 per 100,000 ex- 
posed. With the exception of cancer of the stomach and liver, and 
cancer of the female genital organs, more deaths are charged to 
this residual title than to any of the other separate headings relat- 
ing to malignant growths. 

There was only a very small fluctuation in the death rate during 
the several years which constitute the period to which this report 
relates. This same phenomenon is in evidence for the expanding 
Registration Area of the United States. The death rate for this 
cause, however, is considerably higher in the latter experience for 
these forms of cancer than among the insured group. 

The total death rate for the insured white experience was 10.1 
per 100,000 exposed as compared with 7.6 for the colored experi- 
ence. In each, the mortality among males was higher than among 
females, although this is much more pronounced among the white 
policyholders than among the colored. This excess for males is 
accounted for, in part, by the fact that all deaths from cancers of 
the male genitals are classified under this heading. 



CHAPTER X. 
Ceeebeal Hemorrhage and Apoplexy. 

Cerebral hemorrhage and apoplexy may be, in many cases, the 
terminal stages of several underlying diseases of the cardio- 
vascular-renal system. Unfortunately, classification procedure is 
still rather unsettled with reference to the assignment of the cause 
in cases of terminal cerebral hemorrhage and apoplexy, even when 
the primary disease of the heart, blood, vessels or renal tract is 
mentioned. In some cases the hemorrhage is preferred in the sta- 
tistical registration of the death; in other cases precedence is given 
to the antecedent condition. But in many cases no mention of the 
primary disease is made by the physician and this probably ex- 
plains the large number of deaths which are annually ascribed to 
cerebral hemorrhage and apoplexy in most mortality reports. 
Often these deaths are sudden ones and are certified by coroners 
or by their physicians, who see the cases only after death and who 
are guided by the clinical picture of an apoplexy. Much uncer- 
tainty, therefore, still surrounds the statistics of this disease, and 
of its underlying causes, especially when we consider that only a 
very small proportion of the certifications are confirmed by the 
findings at autopsy. The figures for cerebral hemorrhage and 
apoplexy may be subject to very considerable revision in the future. 

In the six year period 36,638 deaths were assigned to this cause 
in the Industrial experience. This corresponds to an annual aver- 
age rate of 68.1 per 100,000 exposed. The condition stands seventh 
in numerical importance in our list, accounting for 5.8 per cent, 
of all the deaths. We shall see later that this condition is much 
more important with reference to the advanced age periods of life. 
The table on page 174 shows the death rates by color, sex and by 
age period. 

There is no considerable mortality from this cause under 25 
years of age. Beginning with the age period 25 to 34 years there 
is the significant mortality rate of 8.9 per 100,000 persons exposed. 
Between 35 and 44 years a death rate of 35.9 per 100,000 is found 
and thereafter the figures increase very rapidly, nearly trebling in 

173 



174 



MOETALITT STATISTICS OF INSURED WAGE EAENEES. 



TABLE 105. 

Mortality from Cerebral Hemorrhage and Apoplexy, Classified by 

Color, Sex and by Age Period. 

Death Bates per 100,000 Persons Exposed. 1911 to 1916. 

Experience of Metropolitan Life Insurance Company. Industrial 

Department. 





Persons. 


White. 


Colored. 


Age Period. 


Males. 


Females. 


Males. 


Females. 


All ages — one and 
over 


68.1 


60.2 


69.5 


76.9 


97.4 






1 to4 

5 to 9 

10 to 14 

15 to 19 .... 

20 to 24 

25 to 34 

35 to 44 

45 to 54 

55 to 64 

65 to 74 

75 and over . . 


3.1 

.7 

.8 

1.6 

2.9 

8.9 

35.9 

130.6 

359.0 

918.4 

1841.5 


* 2.5 

.7 

.8 

1.2 

2.5 

8.7 

33.8 

123.2 

377.5 

979.0 

2011.7 


2.9 

.6 

.5 

1.4 

2.3 

6.5 

28.3 

113.6 

323.0 

877.7 

1775.5 


7.7 

2.9 

1.6 

2.9 

5.9 

18.9 

54.8 

185.7 

423.2 

855.3 

1605.2 


7.6 

.6 

2.2 

5.0 

7.4 

14.4 

65.7 

223.0 

483.7 

979.5 

1624.2 



some cases, until the maximum rate, 1841.5, is attained for the 
period 75 years and over. 

The rate varies with color and sex. Colored persons show a rate 
for each of the sexes which is at some age periods more than twice 
the death rate of white persons of the same sex group. With in- 
creasing age, however, the excess of colored mortality becomes less 
marked. Indeed, for the age period 65 to 74 years, the rate for 
white males is higher than that for colored males, and at the ex- 
treme of life, ages 75 and over, the rate for the colored of each sex 
IS the lower. In each color group at all ages combined the females 
show a higher rate than the males. This condition is particularly 
marked among colored lives. Analyzing by age period, however, we 
find an interesting difference between the two races. The higher 
rate for white females at all ages one and over combined is evi- 
dently due to the higher average age of the living ; the specific rates 
are lower at each age period, practically, than those for white males. 
Among the colored, on the other hand, a different situation occurs, 
for in this group the rate for females is, with but one exception, 
higher than that for males beginning with the period 10 to 14 
years. The excess is marked in the significant periods of middle 
life and old age. 



CEEEBEAL HEMOREHAGE AND APOPLEXY. 175 

The above variations in the death rate according to color must not 
be stressed too much because of the element of uncertainty in the 
statistical treatment of statements of this cause of death. It must 
be remembered that the higher rate for colored persons may be 
partly explained by the fact that this race has not as yet available 
for its service a medical practice of as high standards as has the 
white race. This latter fact would naturally result in a larger 
number of certifications of " hemorrhage of brain " instead of more 
specific certifications of underlying diseases of the cardio-vascular- 
renal tract. There is sufficient excess, however, in the colored over 
the white rates to justify a conclusion that negroes suffer from 
cerebral hemorrhage and apoplexy somewhat more than white 
people. We may also safely conclude that negro women die from 
this cause more frequently than do negro men at middle and 
advanced life. 

Our present array of statistics does not give a true picture of the 
importance of cerebral hemorrhage and apoplexy at the advanced 
years of life, because only a small proportion of policyholders are 
represented after age 65. It will be instructive to refer at this 
paint to a special study which was made of population mortality 
statistics of old age.* In that report it was pointed out that 
cerebral hemorrhage and apoplexy in the population of the Eegis- 
tration Area of the United States is a most important cause of 
death during old age. In fact, beyond age 65 this condition causes 
more than one death in every eight. 

The table on page 176 presents a comparison of the death rates of 
the general population in the expanding Eegistration Area for 1910 
to 1915 by sex and by age period with those for insured white 
lives, 1911 to 1916. 

We find, in general, higher mortality among insured wage earners 
than in the general population. Thus, between 45 and 54 years, 
insured white male wage earners show a death rate of 123.2 which 
is 141 per cent, of the rate for males in the general population 
(87.4 per 100,000). Between 55 and 64 years, white males in 
the insurance experience registered a rate of 377.5 per 100,000 ex- 
posed, as compared with 276.1 per 100,000 among males in the 
general population. Practically similar excesses in the death rates 
of insured white females were observed. It should be recalled in 

* Dublin, Louis I., ' ' The Vital Statistics of Old Age, ' ' New York Medical 
Journal, May 19, 1917. 



176 MORTALITY STATISTICS OF INSUKED WAGE EAENEKS. 

TABLE 106. 

Mortality from Cerebral Hemorrhage and Apoplexy. 

Death 'Rates per 100,000 Persons Exposed. Classified by Sex and hy Age 
Period. Insured White Lives in Experience of Metropolitan Life In- 
surance Company, Industrial Department (1911 to 1916) and 
General Population Experience of Expanding Begistra- 
tion Area of the United States (1910 to 1915). 





Males. 


Females. 


Age Period. 


M. L. I. Co. 


U. S. Reg. 


Per Cent. 
M. L. I. Co. 


M. L. I. Co. 


U. S. Reg. 


Per Cent. 
M. L. I. Co. 




(White). 


Area. 


of Reg.Area. 


(White). 


Area. 


of Reg. Area. 


All ages — one 














and over 


60.2 


76.6 


78.6 


69.5 


77.7 


89.4 


1 to 4 


2.5 


2.5 


100.0 


2.9 


2.4 


120.8 


5 to 9 


.7 


.9 


77.8 


.6 


.9 


66.7 


10 to 14.... 


.8 


.9 


88.9 


.5 


.8 


62.5 


15 to 19.... 


1.2 


1.8 


86.7 


1.4 


1.5 


93.3 


20 to 24.... 


2.5 


2.9 


86.2 


2.3 


2.6 


88.5 


25 to 34.... 


8.7 


7.4 


117.6 


6.5 


6.3 


103.2 


35 to 44.... 


33.8 


25.2 


134.1 


28.3 


23.9 


118.4 


45 to 54.... 


123.2 


87.4 


141.0 


113.6 


92.7 


122.5 


55 to 64.... 


377.5 


276.1 


136.7 


323.0 


255.0 


126.7 


65 to 74.... 


979.0 


709.0 


138.1 


877.7 


648.7 


135.3 


75 and over. 


2011.7 


1610.2 


124.9 


1775.5 


1622.2 


109.5 



making this comparison, however, that a considerably larger pro- 
portion of deaths, originally reported by physicians as due to 
"paralysis without specified cause," are assigned upon special in- 
quiry to cerebral hemorrhage and apoplexy in the insurance ex- 
perience than in the population experience. This factor, we be- 
lieve, is not powerful enough, however, to account for all of the dif- 
ferences in the two series of death rates for this particular cause. 
There is still a significant excess remaining in the death rates of 
male and female white insured wage earners. 

Trend of the Death Rate from Cerebral Hemorrhage and Apoplexy. 

Considering all the influences at work that affect the registered 
death rate for cerebral hemorrhage and apoplexy, it may be said 
that no well-defined upward or downward tendency can be dis- 
cerned in the mortality from this disease in recent years. There 
was a marked increase in the death rate between 1911 and 1912, but 
this is, in all probability, due to the inauguration in the Statistical 
Bureau of the system of inquiry into returns of "paralysis." It 



CEREBEAL HEMOEEHAGE AND APOPLEXY. 



177 



will be seen that since 1912, during which time this inquiry prac- 
tice as to " paralysis " was carried out uniformly with vigor, there 
has been no significant variation in the death rate from this cause, 
from an average of about 68 deaths per 100,000 persons exposed. 
There is an apparently heavier rate among both colored males and 
females in the later than in the earlier years of this experience. 
This fact is accounted for, to some extent, in our opinion, by 
gradually improving statements of diagnosis on the death cer- 
tificates of colored policyholders and does not indicate, we believe, 
any actual change among colored persons in the conditions causing 
the disease. " Paralysis " without further definition was at one 
time in this experience a very common return of cause of death 
in the case of colored persons. This report is not now relatively so 
frequent. The facts for each of the calendar years in this experi- 
ence are shown in the following table : 

TABLE 107. 

Mortality from Cerebral Hemorrhage and Apoplexy, Classified by 
Color and by Sex. 

Death Rates per 100,000 Persons Exposed. Single Years in Period 1911 

to 1916. 

Experience of Metropolitan Life Insurance Company. Industrial 
Department. 







White. 


Colored. 


Year. 


Persons. 


Males. 


Females. 


Males. 


Females. 


1911 to 1916 


68.1 


60.2 


69.5 


76.9 


97.4 


1916 

1915 

1914 

1913 

1912 

1911 


68.7 
68.5 
69.2 
67.2 
70.3 
64.2 


58.8 
60.1 
59.9 
59.9 
63.5 
59.8 


70.1 
68.1 
72.0 
68.4 
72.2 
65.4 


80.2 
83.5 
76.7 
74.9 
77.3 
67.5 


110.4 
109.8 

98.4 
94.8 
89.8 
77.5 



13 



CHAPTEE XI. 
The Foue Principal Communicable Diseases op Childhood. 

The four principal communicable diseases of childhood, namely, 
measles, scarlet fever, whooping cough and diphtheria constitute 
an interesting group for detailed study and analysis. Together, 
they were responsible for a total of 35,578 deaths during the six 
year period or for 4 per cent, of the entire mortality. If related to 
the period of childhood where nearly all of these deaths occur, 
their importance is more obvious; for they caused 24.3 per cent, 
of all the deaths among children under age 15. Even this high 
proportion is increased as we examine the conditions in the still 
earlier age periods. 

These diseases and conditions are all characterized by their wide 
geographic distribution, their highly infectious character and, 
usually, by their low lethal rates. They are, preeminently, dis- 
eases subject to public health control. In fact they show clearly 
the effect of such control in their rapidly declining relative numer- 
ical importance as causes of death. While the decreases in the 
death rates are not always continuous, they are nevertheless sub- 
stantial, when the entire six year period is considered. Eurther- 
more, the rates give considerable promise of further reduction as 
the diseases come under more complete public health control. 

These four diseases possess certain interesting statistical char- 
acteristics in common. In the case of each, the mortality was 
higher in the earliest age period, 1 to 4 years, than in any other 
age group. This characteristic is most pronounced with whooping 
cough. The death rates rapidly decline from the first age period, 
but continue to show appreciable figures throughout the period of 
childhood. With the single exception of whooping cough, these 
diseases show higher urban than rural rates in populations gen- 
erally. With the exception of whooping cough again, they have a 
higher incidence among males than among females and much 
higher incidences among white children than among colored chil- 
dren. In fact, diphtheria, scarlet fever and measles are not very 

178 



PRINCIPAL COMMUNICABLE DISEASES OF CHILDHOOD. 



179 



serious causes of death among colored children. Whooping cough, 
on the other hand, shows a small excess for females and a death 
rate almost twice as high for colored as for white children of each 
age group. 

We shall consider these causes individually in the following 
order: measles, scarlet fever, whooping cough and diphtheria. 

(a) Measles. 

This disease is defined as an acute and highly contagious fever 
with specific localization in the upper air passages and in the skin. 
It ranks second to diphtheria as a cause of death among the four 
principal communicable diseases of children. As a cause of sick- 
ness it is probably the most widespread of all the communicable 
diseases; but this is compensated by its usually low lethal rate. 
In fatal cases, death is usually due to respiratory complications; 
more particularly to bronchopneumonia. It is frequently followed 
in non-fatal cases by otitis media, and indeed, a considerable pro- 
portion of the deafness in the country has been traced to ear disease 
secondary to measles. 

Measles, like most diseases with skin manifestations, shows a 
much higher death rate among white persons than among colored 
people. As will be observed in the table below, the excess in the 
white rate is most marked in the period under 5 years. Thereafter 
the differences are minor and, in fact, after age 10 the rates for 
colored persons are higher than for white persons. It is true that 
the number of deaths at the ages after age 10 is very small. 

TABLE 108. 

Mortality from Measles, Classified by Color, Sex and by Age Period. 

Death Bates per 100,000 Persons Exposed. 1911 to 1916. 

Experience of Metropolitan Life Insurance Company. Industrial 

Department. 





Persons. 


White. 


Colored. 


Age Period. 


Males. 


Females. 


Males. 


Females. 


AU ages — one and 
over 


8.9 


10.5 


8.6 


5.2 


4.8 






lto4 

5 to 9 

10 to 14.... 
15 to 19.... 
20 and over. 


81.1 

10.9 

1.7 

1.1 

.5 


84.1 

10.5 

1.3 

1.0 

.3 


80.0 

11.4 

1.9 

.9 

.6 


68.6 

9.7 

2.2 

2.9 

.4 


67.3 

11.2 

3.4 

2.1 

.6 



180 MOETALITY STATISTICS OF INSURED WAGE EARNERS. 

The death rate is higher, also, among males than among females. 
This applies especially to the age period 1 to 4 years in which 75 
per cent, of the measles deaths among insured children occur. The 
age at which the highest mortality occurs is the second year of 
life; with this exception, the largest number of deaths in popula- 
tions generally occur among infants under one year of life. The 
deaths of infants do not enter into this study, however, since 
persons are not insured until after the close of the first year of life. 

The table on page 179 presents the death rates by color, sex and 
age period for this disease. 

Very similar relations are found in the death rates of children 
from measles according to sex and age in the general population of 
the expanding Eegistration Area, although the actual death rates 
by age period and sex are slightly different from those found in 
the insurance experience. The measles death rate in the general 
population is considerably lower than that for the insured group. 
This is quite marked in the two age periods under 10 years. After 
10 years, the reverse condition holds> but no great significance can 
be attached to the figures. There are obvious reasons why the 
death rate among insured children should be higher than for chil- 
dren in the general population. In the first place, insured children 
are almost entirely urban residents and the urban death rate is 
about douhle the rural rate for this disease. The population of 



TABLE 109. 
Mortality from Measlbs. 

Death Bates per 100,000 Persons Exposed. Classified hy Sex and hy Age 
Period. Insured White Lives in Experience of Metropolitan Life In- 
surance Company, Industrial Department (1911 to 1916) and 
General Population Experience of Expanding Eegistra- 
tion Area of the United States {1910 to 1915). 





Males. 


Females. 


Age Period. 


M.L.I. Co. 
(White). 


U. S. Reg. 
Area. 


Per Cent. 
M.L.I. Co. 
of Reg. Area. 


M.L.I. Co. 
(White). 


V. S. Reg. 
Area. 


Per Cent. 
M.L.I. Co. 
of Reg. Area. 


AH ages — one 
and over 


10.5 


6.8 


154.4 


8.6 


7.1 


121.1 


lto4 

5 to 9 

10 to 14.... 
15 to 19.... 
20 and over. 


84.1 

10.5 

1.3 

1.0 

.3 


63.4 

7.7 
1.9 
1.8 

.7 


132.6 

136.4 

68.4 

55.6 

42.9 


80.0 

11.4 

1.9 

.9 

.6 


59.8 
7.8 
2.5 
1.8 
1.2 


133.8 

146.2 

76.0 

50.0 

50.0 



PEINCIPAL COMMUNICABLE DISEASES OF CHILDHOOD. 181 

the Registration Area is about equally divided between the urban 
and rural communities. Another factor favoring the Eegistra- 
tion Area is the inclusion in the latter of a small proportion of 
colored lives whose death rates from measles are lower than those 
for whites. The table on page 180 permits a more detailed com- 
parison of the two sets of figures by age and sex. 

The mortality from measles has been showing marked fluctua- 
tions in recent years. This tendency has been observed in both 
the general population and the insured group. The year 1915 
marked the minimum death rate for this disease in both experi- 
ences. For that year the rate was 5.7 per 100,000 exposed for 
Metropolitan Industrial policyholders aged one year or more and 
5.4 per 100,000 exposed for the general population at all ages. In 
this comparison the rates include both white and colored children 
among the insured. The year 1915, it may be remarked, showed 
the lowest death rate recorded for measles for the general popu- 
lation since the beginning of the period covered by the annual mor- 
tality reports relating to the expanding Eegistration Area. The 
year 1916, however, showed a pronounced increase in both experi- 
ences, although this was not as marked among the insured group as 
it was for the expanding Eegistration Area, in which the death 
rate more than doubled. The following table shows the trend of 
the mortality among white and colored policyholders by sex during 
the period 1911 to 1916: 



TABLE 110. 
MORTAIilTT PROM MEASLES, CLASSIFIED BY COLOE AND BY SeX. 

Death Rates per 100,000 Persons Exposed. Single Years in Period 1911 

to 1916. 

Experience of Metropolitan Life Insurance Company. Industrial 
Department. 





Persona. 


White. 


Colored. 


Year. 


Males. 


Females. 


Males. 


Females. 


1911 to 1916 


8.9 


10.5 


8.6 


5.2 


4.8 


1916 

1915 

1914 

1913 

1912 

1911 


9.9 
5.7 
6.9 

12.3 
7.6 

11.4 


12.2 
6.5 
8.1 

14.2 
9.3 

13.0 


9.4 

5.9 

6.5 

12.1 

7.2 
10.5 


4.0 
2.3 

4.8 
7.6 
3.9 
9.4 


3.5 
2.4 
4.0 
6.5 
3.6 
9.2 



182 MOETALITY STATISTICS OF INSURED WAGE EAENEES. 

Comparisons of the death rate for this disease covering long 
periods of years should be made only with certain reservations. 
In fatal cases usually the complications and sequelae are the im- 
mediate causes of death. Only a few years ago there was very 
great understatement of this condition on reports of causes of 
death. This situation has been gradually improved through the 
efforts of National, state and corporate bureaus interested in mor- 
tality statistics. Year after year increasing numbers of physicians 
have learned the importance of stating primary conditions instead 
of sequelae and terminal complications as determining causes of 
death. Measles is one of the diseases the published death rates 
for which have been very materially affected by this influence. 
No doubt there is still some understatement but the condition has 
shown very great improvement. Those who make comparisons and 
analyses based on the published death rates for this disease should 
make due allowance for the influence of these factors. 

(&) SCAELET PeVER. 

Probably there have been few more gratifying evidences of the 
effectiveness of public health activity in this country than the con- 
sistent decrease in scarlet fever mortality. The attention given 
by public health officials to prophylaxis, the increasing rigidity of 
school inspection, the education of the public on the necessity of 
care and precaution against the spread of the disease, have all been 
potent factors in lowering the mortality from scarlet fever. There 
has also been more widespread public appreciation, not only of the 
more or less immediately fatal results, but of the serious sequelae 
of the disease. 

There were 4,638 deaths from scarlet fever among Metropolitan 
Industrial policyholders during the period 1911 to 1916. The 
death rate was 8.6 per 100,000 exposed. 

The death rate among white policyholders, both male and female, 
was about four times as high as that for the colored policyholders. 
This- is a condition which has also obtained, year by year, for the 
population of the expanding Eegistration Area. The comparative 
immunity of colored persons to this disease has long been recog- 
nized. The sex incidence for the insured shows a heavier com- 
parative death rate for males over females among white policy- 
holders than among colored ones. The colored experience, how- 
ever, is small, and this comparison is, possibly, not significant. 



PEINCIPAL COMMUNICABLE DISEASES OP CHILDHOOD. 



183 



The age period of heaviest mortality, in the Metropolitan experi- 
ence, is the period 1 to 4 years, during which ages 2,210 deaths or 
47.6 per cent, of the total of 4,638 deaths occurred. The follow- 
ing table gives the death rates by age period for each color and sex 

class : 

TABLE 111. 

Mortality from Scarlet Fever, Classified by Color, Sex and by Age 

Period. 

Death Bates per 100,000 Persons Exposed. 1911 to 1916. 

Experience of Metropolitan Life Insurance Company. Industrial 

Department 







White. 


Colored. 


Age Period. 


Persons. 


Males. 


Females. 


Males. 


Females. 


Ail ages — one and 
over 


8.6 


10.6 


8.6 


2.5 


2.2 


1 to4 

5 to 9 

10 to 14 

15 to 19 

20 to 24 

25 and over. . 


49.0 

22.5 

6.4 

2.8 

1.6 

.5 


53.5 

24.3 

5.8 

3.0 

1.2 

.4 


48.8 

23.4 

7.5 

2.9 

2.2 

.6 


16.0 
8.8 
5.1 
1.0 

.2 


22.2 

6.4 

2.5 

2.3 

.5 

.3 



The sex and age characteristics brought out by examining the 
comparable figures for the expanding Eegistration Area (with the 
population under one year eliminated) do not differ materially 
from those shown above for the Metropolitan experience. It is true 
that the slight excess which is recorded among insured males over 
females is not in evidence for the general population. In the 
latter experience the mortality rate for the period 1910 to 
1915 for males was 7.1 per 100,000 population; this corresponds 
closely to the rate shown for females (7.5). For the age period 
1 to 4 years the insured white male children show a higher rate 
(53.5 per 100,000 exposed) than is in evidence for those of the 
same age group in the general population (45.8) ; the insured 
females of this age group show about the same excess over the 
females in the general population (48.8 as compared with 42.8). 
In the age period 5 to 9 years the insured white males registered a 
higher death rate than did the males of the general population and 
the insured white females also showed a very slight excess. It 
must be borne in mind, however, in making this comparison, that 



184 



MOKTALITY STATISTICS OF INSUEED WAGE EAENERS. 



the colored population in the expanding Eegistration Area is in- 
cluded, and that on account of the extremely low incidence of 
scarlet fever among colored people it is probable that their in- 
clusion in the exposure accounts for a considerable share of the 
excess which is shown for the insured white children. Another 
element which should be considered in comparing the mortality 
from this disease among insured children and those of the general 
population is the far higher proportion of urban exposure among 
the policyholders. The mortality reports covering the general 
population show, year after year, considerably higher death rates 
for scarlet fever in the cities than in the rural communities, and 
the rates for the insured do not have the benefit of much rural ex- 
posure. The following table shows, side by side, the figures for 
males in the expanding Eegistration Area compared with those for 
white insured males; also the figures for females in the Eegistra- 
tion Area compared with those for white insured females: 



TABLE 112. 

Mortality from Scarlet Fever. 
Death Bates per 100,000 Persons Exposed. Classified hy Sex and hy Age 
Period. Insured White Lives in Experience of Metropolitan Life In- 
surance Company, Industrial Department (1911 to 1916) and 
General Population Experience of Expanding Eegistra- 
tion Area of the United States (1910 to 1915). 





Males. 


Females. 


Age Period. 


M. L. I. Co. 

(White). 


U. S. Reg. 
Area. 


Per Cent. 
M. L. I. Co. 
of Reg. Area. 


M. L. I. Co. 
(White). 


U. S. Reg. 
Area. 


Per Cent. 
M. L. I. Co. 
of Reg. Area. 


All ages — one 
and over 


10.6 


7.1 


149.3 


8.6 


7.5 


114.7 


lto4 


53.5 


45.8 


116.8 


48.8 


42.8 


114.0 


5 to 9 


24.3 


22.0 


110.5 


23.4 


23.1 


101.3 


10 to 14.... 


5.8 


6.0 


96.7 


7.5 


7.1 


105.6 


15 to 19.... 


3.0 


2.8 


107.1 


2.9 


3.1 


93.5 


20 to 24.... 


1.2 


1.6 


75.0 


2.2 


2.2 


100.0 


25 and over. 


.4 


.6 


66.7 


.6 


.7 


85.7 



The highest death rate during the period for Metropolitan In- 
dustrial policyholders was that for the year 1911 (13.1) ; the 
death rate for 1913 was 12.7; for 1914, 9.8; for 1912, 9.0. For 
the yeai 1915 there was a decrease to 4.6 and this was followed by 
a further decline in 1916 to 4.1. 



PRINCIPAL COMMUNICABLE DISEASES OF CHILDHOOD. 



185 



This experience corresponds closely to that of the Registration 
Area. The trend of the mortality due to scarlet fever during the 
period 1911-1916 among Metropolitan Industrial policyholders is 
shown by the following table: 

TABLE 113 

Mortality from Scarlet Fever Classified by Color and by Sex. 

Death Bates per 100,000 Persons Exposed. Single Years in Period 1911 

to 1916. 
Experience of Metropolitan Life Insurance Company, Industrial Department. 





Persons. 


White. 


Colored. 


Year. 


Males. 


Females. 


Males. 


Females. 


1911 to 1916 


8.6 


10.6 


8.6 


2.5 


2.2 


1916 

1915 

1914 

1913 

1912 

1911 


4.1 
4.6 
9.8 

12.7 
9.0 

13.1 


4.7 
5.8 
12.1 
16.0 
11.1 
16.2 


4.0 
4.3 
9.7 

12.7 
9.1 

13.6 


2.2 
1.9 
3.3 
3.0 

1.7 
2.8 


1.8 
2.2 
2.9 
2.3 
2.4 
1.3 



It is not necessary to comment in this report, at length, on the 
greatly decreased and almost continuously decreasing mortality 
from scarlet fever as shown both by the experience among Metro- 
politan Industrial policyholders and by the reports of the Bureau 
of the Census since the year 1900. Inasmuch as the mortality 
from this disease is of such great interest from a public health 
standpoint, one cannot fail to be impressed by the great saving of 
life which these reports show — especially when we examine the 
annual Census mortality volumes beginning with the year 1900. 
Special emphasis should be laid on this point: great as is the de- 
crease in the mortality as indicated by the published death rates for 
the Registration Area, there has been a still greater actual decrease. 
The published death rates for scarlet fever have been materially 
increased by the educational work of public and corporate registra- 
tion offices in securing increased precision of statement of causes 
of death. 

In a recent study of the mortality of childhood,* it was shown 
that scarlet fever, while unimportant as a cause of death in the 

* * ' The Mortality of Childhood, ' ' Dublin, Louis I. Read at the Seventy- 
ninth Annual Meeting of the American Statistical Association, Philadelphia, 
December 27, 1917. Published in Quarterly Publications of the American 
Statistical Association, March, 1918. 



186 



MOETALITY STATISTICS OF INSUKED WAGE EARNERS. 



first year of life caused 1.7 per cent, of all the deaths between one 
and two years of age in the Eegistration Area during the period 
1910 to 1915; 4.7 per cent, between two and three years; 7.0 per 
cent, between three and four years and 7.6 per cent, during the 
fifth year of life. During the second quinquennium 7.1 per cent, 
of all of the deaths were ascribed to scarlet fever. This percent- 
age dropped to 3.0 during the third quinquennium. 

(c) Whooping Cough. 

Like measles, whooping cough is seldom fatal when uncom- 
plicated. When whooping cough causes death it is usually through 
terminal pulmonary conditions, bronchopneumonia in particular. 
Because of its very wide prevalence it is, like measles again, a very 
dangerous disease and one which stands high among the fatal 
affections of children. In all, 3,075 deaths were caused by whoop- 
ing cough among policyholders during the period 1911 to 1916, 
corresponding to a rate of 5.7 per 100,000 exposed at all ages. 

The disease is limited almost entirely to the ages of childhood. 

Of all the deaths, 98.2 per cent, occurred among children between 

one and nine years old, and 86.7 per cent, of the decedents were 

between one and four years of age. There is, therefore, very little 

room for a discussion of whooping cough mortality by age period 

apart from the first two quinquennia of life. The following table 

shows the facts for the ages under 10 years for each color and sex 

group : 

TABLE 114. 

Mortality from Whooping Cough, Classified by Color, Sex and by 

Age Period. 

Death Bates per 100,000 Persons Exposed. 1911 to 1916. 

Experience of Metropolitan Life Insurance Company. Industrial 

Department. 





Persons. 


White. 


Colored. 


Age Period. 


Males. 


Females. 


Males. 


Females, 


All ages — one and 
over 


5.7 


4.7 


5.6 


9.2 


9.3 






lto4 

5 to 9 

10 and over . . 


59.1 

4.9 

.1 


42.0 

3.0 

.1 


60.9 

4.9 

.1 


151.3 

12.7 

.2 


173.9 

17.3 

.4 



PEINCIPAL COMMUNICABLE DISEASES OF CHILDHOOD. 



187 



Unlike the other communicable diseases of children the death 
rate for whooping cough is considerably higher among colored than 
among white children. In fact in the age period of 1 to 4 years, 
the mortality from whooping cough among colored boys and girls 
is approximately three times as high as among white children 
of the same ages. The disease is also more prevalent among 
females than among males. This is true for each of the significant 
age periods and for each race. Similar relations are found to 
exist in the data for the population of the Eegistration Area. The 
following table which is limited to the significant age periods will 
serve as a basis for comparison of the mortality from this disease 
in the two experiences: 

TABLE 115. 
Mortality from Whooping Cough. 
Death Bates per 100,000 Persons Exposed. Classified ty Sex and hy Age 
Period. Insured White Lives in Experience of Metropolitan Life In- 
surance Company, Industrial Department (1911 to 1916) and 
General Population Experience of Expanding Eegistra- 
tion Area of the United States {1910 to 1915). 





Males. 


Females. 


Age Period. 


M.L.I. Co. 
(White). 


U. S. Reg. 
Area. 


Per Cent. 
M.L.I. Co. 
of Reg. Area. 


M.L.I. Co. 

(White). 


V. S. Reg. 
Area. 


Per Cent. 
M.L.I. Co. 
Of Reg. Area. 


lto4 

5 to 9 

10 and over. 


42.0 

3.0 

.1 


40.0 

3.2 

.1 


105.0 

93.8 

100.0 


60.9 

4.9 

.1 


55.6 

4.6 

.2 


109.5 

106.5 

50.0 



In all comparisons between the mortality experience of Metro- 
politan Industrial policyholders and of the expanding Eegistration 
Area, for whooping cough, we should not lose sight of the fact that 
of the four chief epidemic diseases known as " children's diseases," 
namely, measles, scarlet fever, diphtheria and whooping cough, the 
last named is the only one for which the mortality is higher in 
rural than in urban districts. The fact that the rural population 
in the Eegistration Area is large and that among the Industrial 
policyholders of the Company it is small, must, therefore, always 
be considered in comparing the two experiences. 

The trend of whooping cough mortality has been downward since 
1911. The variations in the rate from year to year are largely 
accounted for by the epidemic character of the disease. The rate 
for 1916, for example, rose very appreciably over that for 1915 but 



188 



MORTALITY STATISTICS OF INSURED WAGE EARNERS. 



is nevertheless much lower than the rate for 1911. The trend 
corresponds closely with that in the expanding Eegistration Area, 
but for both experiences it may safely be said that a large measure 
of mortality^ entirely unnecessary and subject to ready control, 
would be eliminated if the necessary steps were taken to impress 
upon the public the truly dangerous character of the disease and to 
prevent children from coming in contact with those afflicted. The 
following table shows the figures for whooping cough for each of 
the six years: 

TABLE 116. 
MOKTALITY FROM WHOOPING COUGH, CLASSIFIED BY COLOB AND BY SEX. 

Death Bates per 100,000 Persons Exposed. Single Years in Period 1911 

to 1916. 

Experience of Metropolitan Life Insurance Company. Industrial 

Department. 





Persons. 


WUte. 


Colored. 


Year. 


Males. 


Females. 


Males. 


Females. 


1911 to 1916 


5.7 


4.7 


5.6 


9.2 


9.3 


1916 

1915 

1914 

1913 

1912 

1911 


5.8 
4.7 
5.8 
5.9 
5.1 
7.1 


4.9 
4.3 
4.7 
4.5 
4.3 
5.5 


6.3 

4.6 
5.6 
5.8 
4.9 
6.8 


7.3 

6.8 
10.0 
10.5 

7.9 
13.3 


6.5 

6.6 

10.6 

11.1 

8.3 

13.5 



As with all epidemic diseases there is, among physicians, a tend- 
ency in fatal cases to report on death certificates the terminal com- 
plication to the exclusion of the primary cause. The fact that the 
profession has been less prone to do this in later years than in 
earlier ones affects very materially the comparability of a series 
of death rates for whooping cough extending over a long period of 
years Unless the compiling offices, which publish figures for 
different areas, have been equally assiduous in their efforts to 
correct these careless statements of cause of death, the compara- 
bility of one set of death rates with another is extremely question- 
able. When allowance is made for this factor, it is evident that 
there has been a considerable decrease in the mortality in the ex- 
panding Eegistration Area of the United States since 1900, 
although the published figures themselves, if not competently and 
critically analyzed, do not indicate this. Thus, the published 
annual average death rate in the expanding Eegistration Area for 



PRINCIPAL COMMUNICABLE DISEASES OF CHILDHOOD. 



189 



the period 1901 to 1905 was 10.9 per 100,000 population, which is 
but little higher than the 10.2 in that area for the year 1916. 
There has been, however, as a matter of fact, a greater decrease in 
the actual mortality from whooping cough than these figures indi- 
cate, because the earlier compilations are not based on so high a 
proportion of accurate statements of the primary cause of death 
as are the later ones. 



(d) DiPHTHEEIA AND CeOUP. 

The deaths included under this title are very nearly all certified 
in modern practice as due to "diphtheria." The former usage of 
the words " croup " and " membranous croup " as synonyms for 
diphtheria is no longer current. It is believed that the statistics on 
diphtheria in this report are especially accurate, first, because of 
the characteristic and, for the most part, unmistakable clinical 
picture in fatal diphtheria and, second, because of the care taken 
in this ofBce to secure as accurate a statement of the cause of death 
from the physician as possible. 

TABLE 117. 
Mortality from Diphtheria and Croup, Classified by Color, Sex and 

BY Age Period, 

Death Bates per 100,000 Persons Exposed. 1911 to 1916. 

Experience of Metropolitan Life Insurance Company. Industrial 

Department. 





Persons. 


White. 


Colored. 


Age Period. 


Males. 


Females. 


Males. 


Females. 


All ages — one and 
over 


24.3 


29.8 


23.8 


9.6 


8.6 






lto4 

5 to 9 

10 to 14 

15 to 19 

20 to 24 

25 to 34 

35 to 44 

45 and over. . 


152.2 

66.1 

13.8 

3.0 

1.6 

1.3 

.9 

.8 


165.3 

68.1 

12.6 

3.0 

1.5 

.8 

1.0 

.7 


149.2 

70.0 

16.0 

3.1 

1.5 

1.5 

.9 

.8 


90.4 

31.8 

8.2 

2.2 

2.3 

.7 

1.0 

.7 


75.5 
35.2 
10.3 
3.2 
1.6 
2.3 
1.0 
1.1 



Diphtheria begins to assume importance as a cause of death in 
the second year of life. In the third year of life, between two and 
three years of age, it is the third cause of death in numerical im- 
portance. Between three and four years, between four and five 



190 



MOKTALITT STATISTICS OF INSUEED WAGE EAENEES. 



years and in the age period five to nine years, diphtheria is the 
first cause of death in order of numerical significance. In the 
five year age period ten to fourteen years, this disease constitutes 
the third cause of death in numerical rank. There is an appre- 
ciable death rate from the disease at the various ages in adult life. 
The age statistics for the disease are given in the table on page 189. 
As was the case for scarlet fever and measles, both colored males 
and females show very much lower death rates for diphtheria than 
do white males and females. Between one and four years of age, 
the death rate of females from diphtheria is lower than that for 
males among both the white and colored race groups in this experi- 
ence. Beginning with the age period five to nine years, however, 
and up to twenty years of age the mortality for females from diph- 
theria is significantly higher than for males. This applies to both 
the white and colored groups. 

Death Rate from Diphtheria among Insured Children of White 

Wage Earners and among Childr&n in the Population of the 

Expanding Registration Area Compared. 

At the ages under 15 years, the diphtheria death rates of both 
male and female children of insured wage earners are higher than 



TABLE 118. 

Mortality from Diphtheria and Croup. 

Death Eates per 100,000 Persons Exposed. Classified hy Sex and hy Age 
Period. Insured White Lives in Experience of Metropolitan Life In- 
surance Company, Industrial Department (1911 to 1916) and 
General Population Experience of Expanding Registra- 
tion Area of the United States (1910 to 1915). 





Males. 


Females. 


Age Period. 


M. L. I. Co. 

(White) . 


U. S. Reg. 
Area. 


Per Cent. 
M. L. I. Co. 
of Reg. Area. 


M. L. I. Co. 
(White). 


U. S. Reg. 
Area. 


Per Cent. 
M. L.I. Co. 
of Reg. Area. 


All ages — one 
and over 


29.8 


17.2 


288.8 


23.8 


17.3 


137.6 


lto4 

5 to 9 

10 to 14.... 
15 to 19.... 
20 to 24.... 


165.3 

68.1 

12.6 

3.0 

1.5 


127.3 

48.7 

11.4 

3.4 

1.7 


129.9 
139.8 
110.5 

88.2 
88.2 


149.2 

70.0 

16.0 

3.1 

1.5 


113.8 

51.8 

13.1 

3.7 

2.2 


131.1 
135.1 
122.1 

83.8 
68.2 



PEINCIPAL COMMUNICABLE DISEASES OF CHILDHOOD. 



191 



the corresponding rates among children in the expanding Eegis- 
tration Area of the United States. Between one and four years 
the excess amounted to practically 30 per cent., and between five 
and nine years, to practically 40 per cent, for insured males, and to 
35 per cent, for females. The table on page 190 gives a compari- 
son of the chief facts of diphtheria mortality at the ages under 35 
years for both the insurance and the population experience. 

Trend of the Death Rate for Diphtheria. 

Barring two years in this experience, 1911 and 1913, there has 
been a slightly downward general tendency of the death rate from 
diphtheria. This corresponds fairly well to the tendency observed 
in the experience of the expanding Eegistration Area of the United 
States. The various methods employed in the control of diph- 
theritic infection and in the reduction of case mortality have been 
productive of results in those countries which have fairly well 

TABLE 119. 

Mortality from Diphtheria and Croup, Classified by Color and by Sex. 

Death Bates per 100,000 Persons Exposed. Single Years in Period 1911 

to 1916. 

Experience of Metropolitan Life Insurance Company. Industrial 

Department, 





Persons. 


White. 


Colored. 


Year. 


Males. 


Females. 


Males. 


Females. 


1911 to 1916 


24.3 


29.8 


23.8 


9.6 


8.6 


1916 

1915 

1914 

1913 

1912 

1911 


21.0 
21.4 
25.7 
27.2 
24.5 
27.3 


25.4 
26.3 
30.8 
33.3 
30.5 
34.0 


20.4 
20.7 
25.8 
26.7 
23.5 
26.6 


8.5 

8.5 

7.1 

11.7 

11.2 

10.7 


7.8 
8.4 
10.6 
8.8 
7.8 
7.9 



organized systems of preventive medicine. In the United States, 
for instance, the death rate of the Eegistration Area was 43.3 per 
100,000 persons in 1900, and 15.7 in 1915, the latter rate being 
the lowest recorded in any of the years since 1900. It may be ex- 
pected that from time to time epidemics of this disease will serve 
to raise the rate somewhat, but, in the long run, the various pre- 
ventive measures employed, especially the administration of diph- 



192 MOKTALITY STATISTICS OF INSURED WAGE EAENEES. 

theria antitoxin, the extension of school medical inspection, the 
effective quarantine of cases and the detection of atypical carriers, 
may be depended upon to still further reduce mortality from this 
cause. 

The table on page 191 gives the facts for each calendar year, 1911 
to 1916, in this experience. 



CHAPTER XII. 

DiAEEHEA AND EnTEEITIS. 

The data for diarrhea and enteritis presented in this report do 
not distinguish between infantile diarrhea as classified under Title 
No. 104 of the International List, and diarrhea and enteritis 
(affecting persons two 3-ears of age and oyer) as compiled under 
Title No. 105. The largest proportion of the deaths from infantile 
diarrhea and enteritis occurs in the general population under one 
year of age. Since no persons under one year of age are included 
in this insurance experience, a distinction in our figures of the 
type of diarrhea would affect only those deaths between ages one 
and two. These have no great significance. This accounts for the 
decision to combine the two titles. There were included under the 
title, thus understood, all forms of inflammatory, ulcerative or 
catarrhal conditions of the intestines or of the gastroenteric tract 
where the intestines were chiefly involved, except those definitely 
reported as due to tuberculous, cancerous, dysenteric or other 
primary factors. 

It should be remembered that this cause of death may be either 
primary or secondary. Only the presumably primary cases are 
listed in this experience, and these cases result, especially among 
children, from the use of improper food, from various toxic sub- 
stances produced in the decomposition of food, from the extreme 
heat of summer ; or, as in senility, from changes in the constitution 
of intestinal secretions. These constitute the larger proportion 
of the cases in the insurance experience. The secondary cases of 
diarrhea and enteritis follow certain infectious diseases such as true 
dysentery and typhoid fever; they also follow circulatory disturb- 
ances which cause a catarrhal enteritis of chronic character, and 
they are common in diseases of the liver and in chronic conditions 
of the heart and lungs, as well as in cachectic conditions such as 
cancer, pernicious anemia and Bright's disease. None of the above 
is included in the present discussion. 

The total number of deaths assigned to the combined title during 
the period between 1911 and 1916 was 14,173. These deaths ac- 
14 193 



194 



MORTALITY STATISTICS OF INSURED WAGE EARNERS. 



counted for 3.2 per cent, of the entire mortality and corresponded 
to a rate of 26.3 per 100,000. The rates according to color, sex 
and age are shown in the followinsr table: 



TABLE 120. 

Mortality from Diarrhea and Enteritis, Classified by Color, Sex and 

BY Age Period. 

Death Bates per 100,000 Persons Exposed. 1911 to 1916. 

Experience of Metropolitan Life Insurance Company, Industrial 

Department. 





Peraona. 


White. 


Colored. 


Age Period. 


Males. 


Females. 


Males. 


Females. 


AU ages — one and 
over 


26.3 


28.2 


24.6 


26.4 


27.7 






1 to 4 

5 to 9 

10 to 14 

15 to 19 

20 to 24 

25 to 34 

35 to 44 

45 to 54 

55 to 64 

65 to 74 

75 and over. . 


208.7 

8.8 

2.4 

1.9 

2.8 

4.5 

7.7 

10.9 

28.2 

80.3 

182.5 


210.6 

8.2 

2.1 

1.2 

1.8 

4.4 

8.0 

10.1 

25.6 

63.8 

180.2 


197.1 
8.4 
2.0 
1.4 
2.9 
3.6 
5.7 
8.9 
25.1 
86.8 

183.3 


298.0 

10.1 

3.8 

7.0 

3.6 

5.9 

10.8 

14.7 

43.2 

76.8 

150.9 


249.4 

16.9 

6.8 

6.7 

6.3 

8.7 

14.5 

24.3 

51.9 

117.4 

208.7 



The highest death rates in this experience are recorded in the 
first and last age periods, namely, 1 to 4 years and over 75 years. 
The minimum rate is in the period 15 to 19 years among the whites 
and in the period 20 to 24 years among the colored. There is con- 
siderable variability in the rates for the colored race by age period. 
From the minimum at 20 to 24 years the rates rise regularly and, 
after age 45 is reached, very rapidly, to their maximum in advanced 
old age. The period 65 to 74 years is an important one from the 
point of view of mortality from diarrhea and enteritis. 

Colored persons, especially when considered for specific age 
periods, show higher rates than do white persons. The single ex- 
ception is for males 75 years and over. It is quite possible that 
even this exception would be eliminated if the figures for colored 
males 75 and over were based on a larger experience. A feature 
of the colored experience is the maintenance of a comparatively 
high rate in the period of early adult life when the very lowest 
figures prevail for the whites. Thus, in the period between 15 to 



DIARRHEA AND ENTERITIS. 



196 



19 years, the rate for colored lives is more than four times as high 
as for white lives. 

The ratios of the death rates of the sexes vary for the two races. 
Among insured white lives the total rate is higher for males than 
for females but this is due principally to the higher mortality in the 
period of early childhood. In the period of old age the rates are 
higher for females. Colored females have higher rates than the 
males virtually throughout life with the exception of the period 
under five years. The excess in the rate of females is especially 
marked in the ages after 65 years. 

Comparison of Mortality from Diarrhea and Enteritis among In- 
sured Wage Earners and among the General Population of 
the Expanding Registration Area. 

At the important age periods, that is, under 5 years and at 75 
years and over, insured lives show lower death rates from these 
causes than are found in the population of the Eegistration Area 
of the United States. The single exception is found among the 
males 75 and over, but even there the difference is not marked. At 



TABLE 121. 

Mortality fkom Diakbhea and Enteritis. 

Death Bates per 100,000 Persons Exposed. Classified by Sex and hy Age 

Periods. Insured White Lives in Experience of Metropolitan Life 

Insurance Company, Industrial Department {1911 to 1916) 

and General Population of Expanding Registration Area 

of the United States {19 W to 1915). 





Males. 


Females. 


Age Period. 


M. L. I. Co. 

(WMte) . 


U. S. Reg. 
Area. 


Per Cent. 
M. L. I. Co. 
of Reg. Area. 


M. L. I. Co. 
fWhlte). 


U. S. Reg. 
Area. 


Per Cent. 
M. L. I. Co. 
of Reg. Area. 


All ages — one 
and over .... 


28.2 


28.0 


100.7 


24.6 


28.9 


85.1 


lto4 


210.6 


232.3 


90.7 


197.1 


210.0 


93.9 


5 to 9 


8.2 


8.0 


102.5 


8.4 


8.0 


105.0 


10 to 14.... 


2.1 


2.2 


95.5 


2.0 


1.9 


105.3 


15 to 19.... 


1.2 


1.5 


80.0 


1.4 


1.7 


82.4 


20 to 24.... 


1.8 


1.9 


94.7 


2.9 


2.9 


100.0 


25 to 34. . . . 


4.4 


3.2 


137.5 


3.6 


3.6 


100.0 


35 to 44. . . . 


8.0 


5.4 


148.1 


5.7 


5.6 


101.8 


45 to 54. . . . 


10.1 


9.1 


111.0 


8.9 


9.9 


89.9 


55 to 64. . . . 


25.6 


19.2 


133.3 


25.1 


22.9 


109.6 


65 to 74.... 


63.8 


48.8 


130.7 


86.8 


63.9 


135.8 


75 and over 


180.2 


173.6 


103.8 


183.3 


223.3 


82.1 



196 



MOETALITY STATISTICS OP INSURED WAGE EARNERS. 



the age periods beyond 25 years there is, generally speaking, an ex- 
cess among the insured over the general population, which is marked 
in the ages after 35 years among males. For the females the two 
sets of figures are not very different. When the urban character of 
the insured industrial population is considered with the fact that 
death rates from diarrhea and enteritis are uniformly higher in such 
areas than in rural communities, the generally favorable conditions 
found to prevail in the insurance experience at the youngest ages 
are even more remarkable. The table on page 195 exhibits the 
figures for the two groups. 

Trend of the Death Rate from Diarrhea and Enteritis. 

In general there has been a reduction in the death rate from this 
condition during the six year period but it has not been marked. 
There was hardly any change in the rate during the first three years ; 
a reduction then occurred for the next two years and in 1916 an 
increase was registered. The rate in that year was not as high as 
during the first three years of experience in the present series. The 
reduction is much more consistent and noteworthy among colored 
males and females than among white. A similar tendency is ob- 
servable in the figures for the expanding Registration Area but 
before any detailed comparisons can be made it must be remembered 
that the insurance figures do not include infants under one. The 
following table presents the figures for the trend of the death rate 
from diarrhea and enteritis among the insured wage earners: 

TABLE 122. 
MORTALITT FROM DiARRBEA AND ENTERITIS, CLASSIFIED BY COLOR AND BY SEX, 

Death Bates per 100,000 Persons Exposed. Single Tears in Period 1911 

to 1916. 

Experience of Metropolitan Life Insurance Company. Industrial 

Department. 





Persons. 


White. 


Colored. 


Year. 


Males. 


Females. 


Males. 


Females. 


1911 to 1916 


26.3 


28.2 


24.6 


26.4 


27.7 


1916 

1915 

1914 

1913 

1912 

1911 


26.3 
24.4 
24.8 
27.7 
27.6 
27.9 


28.7 
26.3 
26.7 
29.9 
28.7 
29.2 


24.9 
22.5 
23.1 
26.0 
25.3 
26.4 


22.2 
25.6 
24.7 
26.2 
32.3 
28.0 


24.3 
25.4 
25.4 
28.3 
32.5 
31.0 



CHAPTEE XIII. 

Diseases and Conditions Incidental to the Mateenal State. 

A study of the mortality of women from the causes and condi- 
tions incidental to childbearing is of singular interest and import- 
ance at the present time in view of the nation-wide campaign for 
the conservation of civilian life during wartime. Deaths of women 
from these causes affect the community deeply because they are for 
the most part preventable, and because they occur at periods of life 
when each death involves serious social loss. The amount of such 
loss is very considerable. Between the ages of 15 and 45 years, the 
diseases and conditions incidental to child-bearing account for more 
deaths of women than does any other disease or class of diseases 
except tuberculosis. An examination of the available facts on 
maternal mortality should, therefore, assist materially in directing 
the plans which may be developed to control these causes of prevent- 
able death, distress and family disintegration. 

The statistical study of these causes of death may be undertaken 
in a number of different ways. The first and usual method is to 
consider these diseases and conditions in a manner similar to other 
causes of death; namely, to relate the deaths to the total popula- 
tion. The rates obtained in this way serve to indicate the proper 
place of puerperal mortality among the several important conditions 
causing death in the whole population. Such mortality rates are, 
however, limited in their utility ; for the deaths are of females alone, 
while the total population contains both males and females. 
Another method often used, is to relate the puerperal deaths to the 
total number of females in the community. This gives another and 
higher rate than the one noted above. The figure thus obtained has 
this limitation: the population refers to all females, whereas the 
deaths are those of women within a limited range of ages. We 
have, therefore, in our treatment followed a third method and have 
presented specific death rates which are limited to females of the 
childbearing ages, namely, 15 to 44 years. In every case we have 
attempted to give the facts for five and ten year age groups during 
this puerperal period. The rates are, therefore, based on deaths 

197 



198 



MOETALITY STATISTICS OF INSUEED WAGE EARNERS. 



and on exposed lives homogeneous with respect to sex and age. A 
very sensitive measure of puerperal mortality is thus obtained. 

In this investigation there were recorded in all 10,056 deaths 
from the diseases and conditions incidental to childbirth in the age 
period 15 to 44 years. This covers the six-year period from 1911 
to 1916 inclusive. These deaths, when related to the 14,694,360 
years of life exposed of women 15 to 44 years of age, correspond to 
a death rate of 68.4 per 100,000 women at these ages. Of the total 
deaths, 8,288 occurred among white females and 1,768 among 
colored females ; the rates per 100,000 for the two races being 66.1 
and 82.3 for the white and colored women respectively. It is, thus, 
shown at the outset that colored females suffer much more seriously 
than do white women from the diseases and conditions incidental to 
childbearing. 

TABLE 123. 

Mortality from Puerperal Diseases and Conditions. Classipied by 
Color. Deaths in Age Period 15 to 44 Years. 



Experience of Metropolitan Life Insurance Company, 
ment, 1911 to 1916. 



Industrial Depart- 





White and Colored. 


White. 


Colored. 


Puerperal Disease or 
Condition. 


i 

Q 




1^1 


1 
Q 




■^2 


f 


o • 




Total puerperal dis- 
eases and con- 
ditions 


10,056 


100.0 


68.4 


8,288 


100.0 


66.1 


1,768 


100.0 


82.3 






Accidents of 
pregnancy 

Puerperal 
hemorrhage. . . 

Other accidents 
of labor 

Puerperal 
septicemia .... 

Puerperal albu- 
minuria and 
convulsions 

Other puerperal 
diseases and 
conditions 


874 

779 

1,020 

4,321 

2,654 

408 


8.7 

7.7 

10.1 

43.0 

26.4 

4.1 


5.9 

5.3 

6.9 

29.4 

18.1 

2.8 


704 
670 

827 
3,494 

2,233 

360 


8.5 

8.1 

10.0 

42.2 

26.9 

4.3 


5.6 

5.3 

6.6 

27.9 

17.8 

2.9 


170 
109 
193 

827 

421 

48 


9.6 

6.2 

10.9 

46.8 

23.8 

2.7 


7.9 

5.1 

9.0 

38.5 

19.6 

2.2 



The 10,056 deaths were due to a considerable number of diseases 
and conditions complicating or characteristic of the puerperal state. 
The most important of these is septicemia, which alone was respon- 



DISEASES INCIDENTAL TO MATERNAL STATE. 199 

sible for 4,331 deaths, or 43.0 per cent, of the total. This condition 
was followed in order, by albuminuria and convulsions with 2,654 
deaths, or 26.4 per cent, of the total. Together, these two definite 
conditions account for 69.4 per cent, of the fatal puerperal cases, 
but it is realized that the actual proportion is even higher. Many 
deaths from puerperal septicemia and puerperal albuminuria are, 
unfortunately, still reported under the disguise of one or another 
of these terms, without qualification, which results in their assign- 
ment to conditions which are not classified under the puerperal 
total. 

The table on page 198 shows the number and percentage of deaths 
as well as the rates per 100,000 exposed from the several conditions 
incidental to childbirth; distinction is made as to the color or race 
of the decedents. 

It would be interesting to classify these deaths according to the 
period of their occurrence, that is, whether during pregnancy, at 
confinement or during the puerperium. Unfortunately, present 
methods of certification and classification of these diseases make it 
impossible to draw such distinctions. To be sure the accidents of 
pregnancy occur in the antepartum period. The deaths from puer- 
peral hemorrhage and from " other accidents of labor " are clearly 
associated with labor. On the other hand, such titles as puerperal 
septicemia and puerperal albuminuria and convulsions, which relate 
to the largest number of deaths, may cover all three periods in the 
puerperal state. Puerperal septicemia is most often a complication 
of labor and of the postpartum period, although a considerable 
number of deaths are associated with pregnancy as complications of 
abortion, miscarriage, etc. Fatal puerperal albuminuria and con- 
vulsions occur most frequently as complications of labor, less fre- 
quently during pregnancy and least of all during the puerperium. 

Comparing the mortality of the two races, we find but few excep- 
tions to the rule that the death rates of colored women are con- 
siderably higher than those of white women for each of the diseases 
and conditions mentioned. The largest disparity between the two 
races is to be noted for septicemia for which the white and colored 
rates are 27.9 and 38.5 per 100,000 respectively. It is interesting 
to observe that the mortality rate for puerperal hemorrhage is 
slightly lower for colored women as is also the case in the miscella- 
neous group entitled "other puerperal diseases and conditions." 
Even for these conditions the figures require further study before 



200 



MORTALITY STATISTICS OF INSURED WAGE EARNERS. 



conclusions can be drawn. It is a question, if our figures related 
back to the total number of pregnancies rather than to the total 
number of women, ages 15 to 44, whether the rate would show up as 
favorably for colored as for white women. 

Age Incidence of Principal Causes of Maternal Mortality. 

The foregoing observations on maternal mortality are of greater 
import when considered according to the principal age periods. 
Let us first study all of the causes of maternal mortality taken 
together. 

TABLE 124. 

Mortality from Puerperal Diseases and Conditions. "White and 

Colored Females. 

Death Bates per 100,000 Women Exposed, Ages 15 to 44 Years, 1911 to 1916. 

Experience of Metropolitan Life Insurance Company. Industrial 

Department. 



Age Period. 


White Female3. 


Colored Females. 


All ages — 15 to 44 years 


66.1 


82.3 


15 to 19 

20 to 24 


24.3 

72.1 
93.0 
62.2 


93.4 
100.7 


25 to 34 


88.3 


35 to 44 


56.7 



Considering white women alone, the least death rate for all dis- 
eases and conditions incidental to childbirth was registered in the 
age period 15 to 19 years, namely 24.3 per 100,000. The rate 
rises rapidly to a maximum of 93.0 in the age period 25 to 34 years 
and then declines to 62.2 for the ten year period 35 to 44 years. 
Among colored females, however, we observed markedly different 
age characteristics of maternal mortality. The rate of mortality 
among colored females between 15 and 19 years was 93.4 per 
100,000, the same rate, practically, as was observed in the period of 
maximum incidence, 25 to 34 years, among white females. From 
this high and damaging rate in the fourth quinquennium of life, the 
rate of maternal mortality among colored females rises to a figure 
of more than 100 per 100,000 exposed between 20 and 24 years and 
declines to a rate of 88.3 per 100,000 exposed in the age period 25 
to 34 years. It is of singular interest to observe that whereas the 
colored female rate for maternal mortality is practically four times 
that of white females for the age period 15 to 19 years and prac- 



DISEASES INCIDENTAL TO MATERNAL STATE. 201 

tically one-third greater than the rate of white females between 
20 to 24 years, for the ages after 25 years and up to 44 years, the 
mortality rates of colored females for all puerperal diseases and 
conditions combined are significantly lower than the rates for white 
females. 

The table on page 200 shows the death rates per 100,000 women 
exposed in each of the color groups in this study, according to age 
periods. 

These data suggest rather than answer inquiry. They call for a 
further display of obstetrical statistics to show the number of births 
to white and colored women at the several age periods of life and in 
relation to these data, the deaths from the various diseases and 
conditions associated with childbearing. Is the high death rate 
from puerperal diseases among j-oung colored females due primarily 
to a very high birthrate or to improper care of parturient colored 
women in the early ages of adult life? Has the factor of ille- 
gitimacy had an effect upon the high mortality of colored mothers ? 
These and other questions could be readily answered by a further 
display of birth and mortality data. 

PuEEPEKAL Septicemia. 

We may now consider the facts for each of the principal puerperal 
diseases in relation to age period. Puerperal septicemia, for white 
women, shows its highest mortality rate between 25 and 34 years, 
and its least rate between 15 and 19 years. Among colored women, 
there is an almost uniform and very high rate between 15 and 24 
years with only a slight decline during the period 25 to 34 years. 
For the age group 35 to 44 years, the rates for white and colored 
women for puerperal septicemia are practically the same. The 
outstanding feature of mortality from puerperal septicemia there- 
fore is the gradually rising rate among white females to the maxi- 
mum in the age period 25 to 34 years and the very high and prac- 
tically stationary rate for colored females for nearly twenty years 
of life between the ages 15 and 35. In the age period 15 to 19 
years, puerperal septicemia shows a rate very nearly four and a half 
times as high among colored as among white women, although at the 
older ages the rates for the two races approximate each other. 
These facts are shown in Table 125 following: 



202 



MORTALITY STATISTICS OF INSUEED WAGE EARNERS. 



TABLE 125. 

Mortality from Puerperal Septicemia. White and Colored Females. 

Death Bates per 100,000 Women Exposed, Ages 15 to 44 Years, 1911 to 1916. 

Experience of Metropolitan Life Insurance Company. Industrial 
Department. 



Age Period. 


White Females. 


Colored Females. 


All ages — 15 to 44 years 


27.9 


38.5 


15 to 19 


10.7 
32.8 
40.7 
21.9 


46.3 


20 to 24 


49.4 


25 to 34 


42.5 


35 to 44 


22.2 







Puerperal Albuminuria and Convulsions. 

A somewhat similar relation is also to be noted with reference 
to the facts for puerperal albuminuria and convulsions, under which 
title-heading deaths from puerperal nephritis and puerperal uremia 
are also counted. Among white women, the rate is lowest between 
the ages 15 and 19. The rate rises rapidly to its maximum, 22.6. 
This remains stationary between 20 and 35 years of age. Colored 
females show the maximum rate in the first age period under obser- 
vation, 15 to 19 years, namely, 36.9 per 100,000, with a gradual 
decline to a minimum at the latest age period, 35 to 44 years, 13.0. 
It should be noted that, in the age period 15 to 19 years, colored 
females show a death rate for this cause nearly four times that for 
white females. Table 126 gives the facts for puerperal albuminuria 
and convulsions: 

TABLE 126. 



Mortality from Puerperal Albuminuria and Convulsions. 

Colored Females. 



White and 



Death Bates per 100,000 Women Exposed, Ages 15 to 44 Years, 1911 to 1916. 

Experience of Metropolitan Life Insurance Company. Industrial 
Department. 



Age Period. 


White Females. 


Colored Females. 


All ages — 15 to 44 years 


17.8 


19 6 






15 to 19 


9.5 
22.6 
22.6 
14.9 


36 9 


20 to 24 


23 


25 to 34 


15 7 


35 to 44 


13 







DISEASES INCIDENTAL TO MATERNAL STATE. 



203 



Accidents of Peegnanct. 

Many conditions are included under this head the more impor- 
tant of which are abortions, accidental and self induced, premature 
birth, and extra uterine or tubal gestation. The death rate among 
white women is comparatively low until age 25 is reached. The 
maximum rate, 8.7 per 100,000 is found in the age period 25 to 34 
years. The rate declines appreciably thereafter. Among colored 
women, however, it is uniformly higher at every age than among 
white women but this is especially marked at the ages under 25. 
Between 20 and 25 years the death rate (10.3) is more than twice 
the white rate. The figure declines somewhat between the ages 25 
and 34 and more markedly between 35 and 44 years. 

It is a matter of some interest that a very large proportion of 
these fatal cases are the direct result of attempts at abortion. In 
spite of the many efforts to cloak this condition, we have record of 
67 such fatal cases in the Industrial mortality experience of 1917 
alone. Many more cases certainly occurred but were not reported. 
The facts would appear to indicate a wide prevalence of this dan- 
gerous and criminal practice. Our data comparing the two color 
or race classes according to age periods are shown below : 

TABLE 127. 

Mortality from Accidents op Pregnancy. White and Colored Females. 

Death Bates per 100,000 Women Exposed, Ages 15 to 44 Years, 1911 to 1916. 

Experience of Metropolitan Life Insurance Company. Industrial 
Department. 



Age Period. 


White Females. 


Colored Females. 


All ages — 15 to 44 years 


5.6 


7.9 






15 to 19 


1.3 
4.7 
8.7 
6.0 


2.1 


20 to 24 


10.3 


25 to 34 


9.9 


35 to 44 


7.0 







Pueeperal Hemoeehage. 

The deaths under this title include those reported from placenta 
previa and retained meiribranes provided there is no evidence of 
septicemia as a complication. The mortality rate is least at the 
youngest ages. Among white women, the rate reaches its maxi- 
mum at the oldest ages, i. e., 35 to 44 years, when it is 8.1 per 



204 



MORTALITY STATISTICS OF INSURED WAGE EARNERS. 



100,000. Among colored women the highest rate is found between 
25 and 34 years. It is an interesting fact previously observed by 
obstetricians that colored women at the older ages of the child- 
bearing period suffer from puerperal hemorrhage much less fre- 
quently than do white women. Table 138 gives the facts for puer- 
peral hemorrhage: 

TABLE 128. 

Mortality from Puerperal Hemorrhage, White and Colored Females. 

Death Bates per 100,000 Women Exposed, Ages 15 to 44 Years, 1911 to 1916. 

Experience of Metropolitan Life Insurance Company. Industrial 
Department. 



Age Period. 


White Females. 


Colored Females. 


AH ages — 15 to 44 years 


5.3 


5 1 






15 to 19 


.8 
3.3 
7.5 
8.1 


.9 


20 to 24 


6 1 


25 to 34 


64 


35 to 44 


5.1 



Other Accidents of Labor. 

This title covers such deaths as are due to breech presentation, 
Caesarian section, and forceps operations and those attributed to 
dystocia, " injury at birth " and to " childbirth " or " confinement," 
with no further description. In the period 15 to 19 years, the first 
age period for which we have figures for these causes, among colored 
females the rate was five times that of white females, the figures 
being 6.7 and 1.4 per 100,000 living, respectively. Thereafter, the 
rates for the two races are not so divergent; in fact, after age 25 
they are nearly identical. The maximum rate among white women 
is found in the age period 25 to 34 years when it is 9.4 per 100,000 
and the maximum among colored women in the earlier age group 
20 to 24 years, when the rate is 10.8. The data for these "other 
accidents of labor " are displayed in Table 129 on the next page. 



Comparison of Insurance data, 1911 to 1916, with Population Data, 

1910 to 1915. 

The above facts relate to a large group of female Industrial 
policyholders. For purposes of comparison we may turn profitably 
to the figures for women in the expanding Eegistration Area of 



DISEASES INCIDENTAL TO MATERNAL STATE. 



205 



TABLE 129. 

mortai.ity from "other accidents op labor." white and colore 

Females. 

Death Bates per 100,000 Women Exposed, Ages 15 to 44 Years, 1911 to 1916. 
Experience of Metropolitan Life Insurance Company. Industrial 





Department. 




Age Period. 


White Females. 


Colored Females. 


All ages — 15 to 44 years 


6.6 


9.0 








15 to 19 


1.4 
6.1 
9.4 

7.8 


6.7 


20 to 24 


10.8 


25 to 34 


10.3 


35 to 44 


7.3 



the United States, This is, in fact, the largest group in the gen- 
eral population of the United States for whom death rates may be 
prepared from the published data now available. A number of 
limitations, however, should be pointed out which interfere some- 
what with the complete comparability of the data for insured women 
with those for the general population. The figures for the expand- 
ing Eegistration Area cover the six-year period, 1910 to 1915; the 
Metropolitan figures are for the six-year period, 1911 to 1916. The 
population of the Eegistration Area includes a small proportion of 
colored in addition to the white, whereas the insurance figures are 
for each of the two races taken separately. For the comparison, the 
figures for white insured women alone will be used. There are also 
differences in the geographical areas covered by the two groups. 
The Eegistration Area still excludes most of the southern and a 
number of western states ; the Metropolitan policyholders are repre- 
sented in nearly all of these states. It is clear nevertheless that 
these several differences are not sufficiently important to vitiate the 
comparisons of the mortality rates which we shall make. 

In the six-year period 1910 to 1915, there were 57,013 puerperal 
deaths recorded among women in the Eegistration Area, ages 15 to 
44 years. This corresponded to a death rate of 63.1 per 100,000 
exposed at these ages.* The rate is therefore somewhat less than 

* The aggregate number of years of life of women ages 15 to 44 in the 
Eegistration Area exposed during the six year period 1910 to 1915 inclusive 
was estimated at 90,301,312, from data furnished by the Bureau of the 
Census and by the Prudential Insurance Company of America. 



206 MORTALITY STATISTICS OF INSURED WAGE EARNERS. 

that fei the insured women which was 66.1. The slight excess in 
the rate of mortality from diseases and conditions connected with 
maternity among insured women should not be interpreted too 
closely as an indication of worse conditions respecting childbirth 
among the wage earning element of the population, in view of the 
higher birth rate which prevails among the policyholders than 
among the population at large and for other reasons. As was the 
case among the insured women, the most important single items 
included in this mortality study of the general population are 
puerperal septicemia and puerperal albuminuria ; the former being 
responsible for 44.4 per cent, and the latter for 23.9 per cent, of all 
the puerperal deaths. Together, these two conditions are respon- 
sible for 68.3 per cent, of the puerperal deaths ; among the insured 
white women they accounted for 69.1 per cent. The accidents of 
pregnancy occurred in 9.3 per cent, of the cases; among insured 
white women they occurred in 8.5 per cent. The similarity in the 
two sets of figures is marked indeed and serves to confirm the gen- 
eral reliability of the returns in the two series. 

Comparative Age Characteristics of Maternal Mortality. 

The data for the puerperal diseases and conditions in the two 
series are also very similar when studied by age period. Consider- 
ing first all the puerperal causes combined, we find that the death 
rates reach a maximum in both groups in the age period 25 to 34 
years. The mortality among insured women is lower between ages 
15 to 19 years by 10 per cent. In the age group 20 to 24 years and 
in the age periods thereafter up to 44 years of age, maternal mor- 
tality among insured white women is from five to ten per cent, 
higher than among the female general population. 

For puerperal septicemia, the figures are slightly more favorable 
for the insured women. Thus, between the ages 15 to 19, insured 
white women show a death rate from puerperal septicemia which is 
only 83 per cent, of the rate among women in the general popula- 
tion. In the period 20 to 24 years the advantage in favor of the 
insured women is close to 5 per cent, of the population rate. Be- 
tween 25 and 34 years, the rate for the insured women shows an ex- 
cess of nearly 7 per cent. In the last period 35 to 44 years, the 
death rate is practically the same for the two groups. 

The figures for puerperal albuminuria and convulsions are differ- 
ent in several respects from those for puerperal septicemia, the rates 



DISEASES INCIDENTAL TO MATERNAL STATE. 



207 



being on the whole more favorable for the women in the general 
population than for the industrial group. Virtually the same mor- 
tality rates are observed in the two experiences at ages 15 to 19 
years but thereafter, mortality of the insured is considerably higher 
than for women in the Eegistration Area. It is 25 per cent, higher 
at the age period 25 to 34. 

TABLE 130. 

Mortality fkom Ptjerpeeal Diseases and Conbiticns. 

Death Bates per 100,000 Women Exposed. Classified by Age Periods 

between 15 and 44 Years. Insured White Lives in Experience of 

Metropolitan Life Insurance Company, Industrial Department 

(1911 to 1916) and General Population of Expanding 

Eegistration Area of the United States (1910 

to 1915). 





Total-Puerperal State. 


Puerperal Septicemia. 


Puerperal Albuminuria. 


Age Period. 


M. L. I. 

Co. 
(White). 


u. s. 

Reg. 
Area. 


p. c. 

M. L. I. 

Co. or 

Reg. 

Area. 


M. L. I. 
Co. 

(WUte). 


u. S. 
Reg. 
Area. 


p. c. 

M. L. I. 
Co. of 
Reg. 
Area. 


M. L. I. 
Co. 

(WWte). 


Reg. 
Area. 


p. c. 

M. L. I. 
Co. Of 
Reg. 
Area. 


All ages — 15 
to 44 years . 


66.1 


63.1 


104.8 


27.9 


28.1 


99.3 


17.8 


15.1 


117.9 


15 to 19... 
20 to 24. . . 
25 to 34... 
35 to 44... 


24.3 
72.1 
93.0 
62.2 


27.0 
68.9 
84.2 
58.4 


90.0 
104.6 
110.5 
106.5 


10.7 
32.8 
40.7 
21.9 


12.9 
34.4 
38.1 
21.7 


82.9 

95.3 

106.8 

100.9 


9.5 
22.6 
22.6 
14.9 


9.6 
18.3 
18.1 
12.9 


99.0 
123.5 
124.9 
115.5 



Table 130 presents the essential rates for the two series by age 
period not only for the total puerperal state but also for the two 
most important single conditions in this disease group. 

The rates for the other puerperal conditions are comparatively 
low in both groups and do not justify any extended comparisons be- 
tween the insured and the general populations. 



Relative Improvement in Maternal Mortality among Insured Women 
and in the General Population. 

If the composite death rate among insured white women appears 
to be somewhat higher than that for women in the population gen- 
erally it should also be noted that this difference is being progres- 
sively overcome. Thus, in 1911, a death rate of 70.1 per 100,000 
insured white females ages 15 to 44 years was recorded and in 1916, 



208 



MORTALITY STATISTICS OF INSURED WAGE EARNERS. 



a rate of 62.6 per 100,000. This represents a decline of 10.7 per 
cent, in the rate of maternal mortality in the insured group. When 
we compare the 1910 rate among females in the general population 
of the Registration Area, 63.4, with the 1915 rate, 61.6, we find a 
decline of only 2.8 per cent, in maternal mortality. In 1911, the 
rate among the insured women was 9 per cent, in excess of the 
population rate; in 1915, this excess was reduced to only 3 per cent. 
A comparison of the two series of rates annually from 1911 to 191 5< 
the latest year for which these figures are available at this time for 
the Eegistration Area by age, is shown in the following table : 

TABLE 131. 

Mortality from Puerperal Diseases and Conditions. 

Death Bates per 100,000 Women Exposed, Ages 15 to 44 Years. Single 
Years in Period 1911 to 1916. 

Experience of Metropolitan Life Insurance Company, Industrial Depart- 
ment, and of Expanding Eegistration Area of the United States. 





Females, Ages 15 to 44 Years. 


Year. 


Death Rates per 100,000 Women Exposed. 






Insured White 
Women. 


Women In Popula- 
tion, Reg. Area. 


Population, 
Reg. Area Rates. 


1916 


62.6 
63.3 
68.6 
70.5 
62.4 

70.1 

* 


* 

61.6 
64.4 
64.1 
60.7 
64.5 
63 4 


* 


1915 


1 03 


1914 


1 07 


1913 

1912 


1.10 
1 03 


1911 


1 09 


1910 


* 











* Data unavailable. 



There is, therefore, a general tendency for the rate of total 
maternal mortality among insured white females to approximate 
that of females in the general population. 

A greater relative reduction in mortality is also observed for 
puerperal septicemia among insured white females than among 
females in the general population. Thus, in 1911 among insured 
white females, aged 15 to 44 years, we recorded a death rate from 
this condition of 30.6 per 100,000 and in 1916 a rate of 25.3 per 
100,000. This represents a decline of 17.3 per cent. In the ex- 
perience of the Eegistration Area there was a decline in the six 
years between 1910 and 1915 from 29.2 to 25.4 per 100,000 or 13.0 



DISEASES INCIDENTAL TO MATERNAL STATE. 



209 



per cent. In 1915, the rate of mortality from puerperal septicemia, 
the chief cause of death of women in the maternal state, was actually 
lower among insured white females than among females in the gen- 
eral population. The following table gives the chief comparative 
facts for puerperal septicemia in both experiences : 



TABLE 132. 

Mortality from Puerperal Septicemia. 

Death Bates per 100,000 Women Exposed, Ages 15 to 44 Years. 
Years in Period 1911 to 1916. 



Single 



Experience of Metropolitan Life Insurance Company, Industrial Depart- 
ment, and of Expanding Eegistration Area of the United States, 





Females, Ages 15 to 44 Years. 


Year. 


Death Rate per 100,000 Women Exposed. 


Ratio, Insurance 




Insured 
White Women. 


Women in Popu- 
lation, Reg. Area. 


to Population, 
Reg. Area Rates. 


1916 


25.3 

24.8 
28.6 
31.9 
26.9 

30.6 

* 


* 

25.4 
28.7 
29.2 
26.3 
29.9 
29.2 


* 


1915 


.98 


1914 


1.00 


1913 


1.09 


1912 


1.02 


1911 

1910 


1.02 

* 



* Data unavailable. 



We have found from our previous inquiry that the conditions 
classified as puerperal albuminuria and convulsions are second in 
importance among the total causes of maternal mortality. For this 
cause of death we have recorded a steadily rising rate with but one 
exception year by year between 1910 and 1915 for women aged 15 to 
44 years in the experience of the Registration Area and a fluctuating 
rate among white females in the insurance experience. 

The table on page 210 presents a comparison of the data available 
for these conditions among white insured women and among women 
in the population between the ages of 15 and 44 years. 

This is a discouraging picture in view of the well established 
opinion among obstetricians that the largest part of the mortality 
from these conditions may be prevented through adequate medical 
and nursing service carried on during the period of pregnancy. The 
figures clearly indicate a fruitful field for the extension of such 
service to women. This, in fact, is the reason for the general ex- 
15 



210 



MORTALITY STATISTICS OF INSURED WAGE EARNERS. 



tension of the Company's nursing service to women during preg- 
nancy. Through such service the nephritic and hepatic cases will 
undoubtedly be brought earlier under medical observation and many 
cases which would under ordinary circumstances terminate fatally 
as puerperal albuminuria and convulsions will thus be carried safely 
through their confinement. 

TABLE 133. 

Mortality fkom Puerperal Albuminuria and Convulsions. 

Death Bates per 100,000 Women Exposed, Ages 15 to 44 Years. Single 
Years in Period 1911 to 1916. 

Experience of Metropolitan Life Insurance Company, Industrial Depart- 
ment, and of Expanding Eegistration Area of the United States. 





Females, Ages 15 to 44 Years. 


Year. 


Death Rates, per 100,000 Women Exposed^ 


Ratio of Insurance to 




Insured White 
Women. 


Women In Popula- 
tion, Reg. Area. 


Population, 
Reg. Area Rates. 


1916 


18.3 
16.9 
18.0 
19.0 
17.3 

17.1 

* 


* 

16.1 
16.1 
15.4 
14.6 
14.3 
13.7 


* 


1915 


1.05 


1914 


1.12 


1913 


1.23 


1912 


1.18 


1911 


1.20 


1910 


* 











* Data unavailable. 



Accidents of Labor. 

The registered mortality from these causes of death for the group 
of white insured females, shows a general and substantial downward 
trend from 1911 to 1916. The Eegistration Area mortality rates 
show the peculiar phenomenon of a steady downward trend up to 
1913 and a gradual rise in the rate between 1913 and 1915. It is 
not possible to indicate how much of the general decline in mortality 
from this cause among insured white females is due to the work of 
the Visiting Nurse Service. Under the rules of that service, the 
work of the visiting nurse is confined very largely to after-care of 
mothers after childbirth. It is believed, however, that the amount 
of prenatal work already extended to insured women in the Indus- 
trial Department tends in a measure to correct during pregnancy 
the remediable mechanical difficulties which may be encountered 
during labor. The work of the public health nurse for pregnant 



DISEASES INCIDENTAL TO MATERNAL STATE, 



211 



women would necessarily be in the direction of insuring proper 
medical care for women in childbirth. "We show the comparative 
mortality facts for accidents of labor below : 



TABLE 134. 

Mortality from "Other Accidents op Labor." 

Death Bates per 100,000 Women Exposed, Ages 15 to 44 Years. Single 
Years in Period 1911 to 1916. 

Experience of Metropolitan Life Insurance" Company, Industrial Depart- 
ment, and of Expanding Registration Area of the United States. 





Females, Ages 15 to 44 Years. 


Year. 


Death Rates per 100.000 Women Exposed. 


Ratio of Insurance 




Insured 
White Women. 


Women In Popu- 
lation, Reg. Area. 


to Population, 
Reg. Area Rates. 


1916 


6.2 

6.1 

6.2 

7.1 

6.1 

8.2 
* 


* 

5.9 
5.6 
5.4 
5.6 
6.2 
6.1 


* 


1915 


1.03 


1914 


1.11 


1913 


1.31 


1912 


1.09 


1911 


1.32 


1910 


* 











* Data unavailable. 

Puerperal HemorrJiage. 

It has been assumed in obstetrical literature generally that mor- 
tality among women in the wage earning groups of the population 
from puerperal hemorrhage was more common than in general unse- 
lected populations. Our data show, however, a lower death rate 
except in one year, 1914, from this cause among white insured fe- 
males in the families of wage earners than among females in the 
general population of the Eegistration Area of the United States. 
The figures indicate an uncertain tendency in the mortality of both 
groups. Table 135 on page 212 gives a view of the data available. 

Accidents of Pregnancy. 

Comparative mortality from this cause of death shows higher 
death rates in 1913, 1914 and 1915 among insured white females 
than among females in the general population. There seems to be, 
in general, higher mortality from the accidents of pregnancy 
among white females in wage earners' families than among females 



212 



MORTALITY STATISTICS OF INSURED WAGE EARNERS. 



TABLE 135. 

Mortality from Puerperal Hemorrhage. 

Death Bates per 100,000 Women Exposed, Ages 15 to 44 Years. 
Years in Period 1911 to 1916. 



Single 



Experience of Metropolitan Life Insurance Company, Industrial Depart- 
ment, and of Expanding Registration Area of the United States. 





Females, Ages 15 to 44 Years. 


Year. 


Death Rate per 100,000 Women Exposed. 






Insured White 
Women. 


Women In Popula- 
tion Reg. Area. 


to Population, 
Reg. Area Rates. 


1916 

1915 

1914 

1913 


5.2 

5.7 
6.2 
4.6 
4.9 

5.3 

* 


* 

6.0 
6.1 
6.3 
6.2 
5.8 
5.6 


* 

.95 

1.02 

.73 


1912 


.79 


1911 

1910 


.91 

* 



* Data unavailable. 



in the general population. Such data as we have available are given 
in the following table : 

TABLE 136. 



Mortality from Accidents of Pregnancy. 

Death Bates per 100,000 Women Exposed, Ages 15 to 44 Years. 
Years in Period 1911 to 1916. 



Single 



Experience of Metropolitan Life Insurance Company, Industrial Depart- 
ment, and of Expanding Registration Area of the United States. 





Females, Ages 15 to 44 Years. 


Year. 


Death Rates per 100,000 Women Exposed. 






Insured White 
Women. 


Women in Popula- 
tion, Reg. Area. 


Population 
Reg. Area Rates. 


1916 


4.6 
6.1 
6.2 
5.9 

4.8 

6.1 

* 


* 

5.7 
5.5 

5.5 
5.8 
6.2 
6.6 


* 


1915 


1.07 


1914 


1.13 


1913 


1.07 


1912 


.83 


1911 


.98 


1910 


* 











* Data unavailable. 



diseases incidental to maternal state. 213 

Prevention of Maternal Mortality, 

The figures presented in the above tables disclose a large and 
profitable field for intensive public health work. It is no light 
matter that with the present development of sanitary science and 
of preventive medicine there should still be one fatal termination in 
from every 100 to 200 cases of pregnancy and childbirth. Yet this 
is the situation in a number of large centers of population for which 
adequate data are available. As we have pointed out, the puerperal 
conditions in their entirety represent a hazard to the life of women, 
which is second only to that from pulmonary tuberculosis at these 
childbearing ages. The serious social losses resulting from the 
many deaths of women at these ages are now more thoroughly 
realized. Deaths of wives and mothers mean, in most instances, 
the destruction of family ties with their incalculable consequences 
to the community. These facts explain the recent efforts for the 
care of women in pregnancy. Prenatal work is fast becoming an 
integral part of the routine of preventive work of the departments 
of health of many American cities. In some communities, like 
Boston and New York, private agencies cooperating with the visit- 
ing nurse associations, have specialized in the nursing of women 
throughout the period of pregnancy, confinement and after-care. 
Thousands of cases are being cared for each year in prenatal clinics 
and through follow-up and instructive visits by specialized nurses. 
In Boston, the work has been brought to the point where definite 
life saving of both mother and child on a large scale already appears 
evident. Other communities will undoubtedly show similar results 
as their work becomes better established. 

It is among insured women that the best results of a policy of 
life conservation have been obtained. Prom the very beginning, in 
1909, the nursing service of the Metropolitan Life Insurance Com- 
pany considered the care of women after childbirth a major function 
of the service and this has been the policy of the Company since. 
In 1916, out of a total of 160,843 female policyholders visited dur- 
ing illness 41,572 or 25.8 per cent, were cases resulting from diseases 
or conditions of the puerperal state. While the majority of these 
cases involve care of women after normal childbirth, there are many 
cases each year of the abnormal and acute conditions requiring 
intensive nursing care. Thus, in 1916 there were 967 cases of 
puerperal septicemia, 308 cases of albuminuria and convulsions and 



214 MOETALITT STATISTICS OF INSURED WAGE EARNERS. 

3,469 cases of abortion and miscarriage. In all, a total of 243,738 
nursing visits were made in 1916 to these women either before or 
after their confinement. 

It is not surprising, therefore, that we should find a very favorable 
course in the mortality of these insured women from nearly all the 
conditions incidental to ehildbearing. In the six year period be- 
tween 1911 and 1916, the death rate among white female policy- 
holders* from these causes fell 10.7 per cent., the figures for 1911 
and 1916 being 70.1 and 62.6 per 100,000 respectively. The per 
cent, reduction is greater in this period for colored women, namely, 
20.4 pea- cent. The decline in mortality from puerperal septicemia is 
especially marked among white women in this period, being 17.3 per 
cent. With the exception of accidents of pregnancy, the saving in 
mortality between 1911 and 1916 is greater among insured women 
than among women in the population at large between 1910 and 
1915 as represented in the Eegistration Area data. These com- 
parisons, therefore, serve as a strong endorsement of the Company's 
programme for the care of parturient women through public health 
nursing. 

* Ages 15 to 44 years. 



CHAPTER XIV. 

We shall now depart from the practice of discussing in a separate 
chapter the mortality statistics of individual diseases. In each of 
Chapters XIV, XV and XVI we shall group a number of causes of 
death, otherwise unrelated, into chapters of convenient length, and 
shall consider the respective diseases in the order of their decreas- 
ing numerical importance. This seems advisable because the dis- 
eases and conditions thus discussed are not of sufficient numerical 
importance to justify the extensive treatment accorded to those in 
the preceding chapters. This grouping must not be considered as 
an expression of any relation between the diseases ; our arrangement 
is determined only by a consideration of the size of the chapters. 
The present chapter will deal with the following diseases: 

1. Diseases of the Arteries, Atheroma, Aneurism, etc. 

2. Typhoid Fever. 

3. Cirrhosis of the Liver. 

4. Influenza. 

5. Diabetes. 

Diseases of the Aetekies, Atheeoma, Anetjeism^ etc. 

The deaths registered under this title include those certified as 
due to arteriosclerosis, and to other arterial diseases such as fatty 
degeneration of the arterial wall (atheroma) and aneurism of 
various types. The larger proportion of the 9,142 deaths under this 
title, however, relate to general arteriosclerosis. In all, 1.4 per cent, 
of the deaths in the total experience are included. 

Reports on mortality from arteriosclerosis must be accepted with 
caution because of inherent defects in the statistics. It is only in 
recent years that physicians have paid serious attention, in pre- 
paring death certificates, to the arterial diseases as causes of death. 
Increasing popular interest in these diseases has carried with it, at 
the same time, neglect on the part of physicians to specify, in many 
cases, the associated impairments of the heart and kidney, which, if 
they were stated as they should be, would result in the assignment of 
the cause of death to other than arterial disease. There is still, 

215 



216 



MOETALITY STATISTICS OF INSURED WAGE EARNERS. 



therefore, considerable uncertainty as to the full significance of the 
figures on arterial disease mortality submitted in this report. 

The following table shows the death rates from the arterial dis- 
eases, arranged by sex, color and age : 

TABLE 137. 

Mortality kbom Diseases of the Arteries, Atheroma, Aneurism, Etc. 

Death Bates per 100,000 Persons Exposed. 1911 to 1916. 

Experience of Metropolitan Life Insurance Company. Industrial 
Department. 





Persons. 


White. 


Colored. 


Age Period. 


Males. Females. 


Males. 


Females. 


All ages — one and 
over 


17.0 


18.8 


15.1 


21.3 


15.8 






1 to 24 

25 to 34 

35 to 44 

45 to 54 

55 to 64 

65 to 74 

75 and over. . 


.1 

1.6 

5.8 
16.0 
66.0 

298.7 
888.8 


.1 

1.4 

6.6 

21.0 

87.8 

392.7 

1089.5 


t 

.6 

1.7 

8.7 

50.3 

249.8 

804.5 


.3 

7.2 

25.8 

38.8 

79.8 

287.3 

686.0 


.4 

2.9 

8.1 

24.1 

67.8 

210.2 

653.3 



f Less than .05 per 100,000 exposed. 

We find, as in a number of the other degenerative diseases, a 
marked difference in the two races. Colored males, especially at the 
earlier ages of adult life, show much higher mortality rates than do 
white males. Colored females, likewise, up to 64 years, show exces- 
sive rates from this cause. After age 55, there is a reversal of this 
condition and the rates for white lives exceed those for the colored. 
Males show higher rates than females in each race. 

A comparison of the death rates prevailing among the insured 
lives with those in the population of the Eegistration Area shows a 
marked excess in the former group during the significant age 
periods. Thus, between 65 and 74, white insured males have a rate 
nearly 68 per cent, in excess of that of the male population, and 
insured females a rate 63 per cent, in excess of that for females in 
the Eegistration Area. 

The following table gives a few of the comparative facts in the 
two experiences: 



DISEASES OF THE ARTERIES, 



217 



TABLE 138. 

Mortality from Diseases of the Arteries, Atheroma, Aneu^-ism, Etc. 

Death Bates per 100,000 Persons Exposed. Classified by Sex and Age 
Periods. Insured White Lives in Experience of Metropolitan Life In- 
surance Company, Industrial Department (1911 to 1916) and 
General Population of Expanding Begistration Area of 
the United States (1910 to 1915). 





Males. 


Females. 








Per Cent. 






Per Cent. 




M. L. I. Co. 


U. S. Reg. 


M. L. I. Co. 


M. L. I. Co. 


U. S. Reg. 


M. L. I, Co. 




(White). 


Area. 


of Reg. Area. 


(White). 


Area. 


Of Reg. Area. 


25 to 34.... 


1.4 


1.7 


82.4 


.6 


.7 


85.7 


35 to 44.... 


6.6 


5.8 


113.8 


1.7 


2.2 


77.3 


45 to 54.... 


21.0 


17.6 


119.3 


8.7 


8.2 


106.1 


65 to 64. . . . 


87.8 


61.3 


143.2 


50.3 


35.4 


142.1 


65 to 74.... 


392.7 


234.1 


167.7 


249.8 


153.3 


162.9 


75 and over 


1089.5 


983.4 


110.8 


804.5 


743.7 


108.2 



As already pointed out, it is very doubtful whether we have con- 
clusive figures as to the true incidence of these diseases at the pres- 
ent time. The trend of the death rates between 1911 and 1916 may, 
therefore, be no real indication of the general tendency of the dis- 
ease during the period. The uncertainties of diagnosis and certifi- 
cation are still too dominant to warrant drawing any far reaching 
conclusions. The sudden decline in the death rate both among 
white females and white males subsequent to 1914 was clearly the 
result of changed office practise in assigning cases where arterio- 
sclerosis was reported Jointly with a number of other conditions 
such as bronchopneumonia, chronic bronchitis, endocarditis, and 
many other causes. Following the practise of the Census Bureau, 
such cases were, after 1914, assigned not to arteriosclerosis but to the 
accompanying condition. Among insured colored persons, there is 
shown a fairly marked increase in the rates from year to year 
despite the influence of this factor. The figures for the population 
of the Eegistration Area are different in that they show a condition 
of increased incidence from year to year. 

The following table shows the figures for the individual years 
between 1911 and 1916 differentiated by color and sex: 



218 



MOKTALITY STATISTICS OP INSUKED WAGE EAENEES. 



TABLE 139. 

m'^ktality from diseases of the arteries, atheroma, aneurism, etc., 
Classified by Color and by Sex. 

Death Hates per 100,000 Persons Exposed. Single Yea/rs in Period 1911 

to 1916. 

Experience of Metropolitan Life Insurance Company. Industrial 
Department. 





Persons. 


White. 


Colored. 


Year. 


Males. 


Females. 


Males. Females. 


1911 to 1916 


17.0 


18.8 


15.1 


21.3 


15.8 


1916 

1915 

1914 

1913 

1912 

1911 


15.2 
14.4 
18.9 
19.0 
17.6 
17.4 


16.5 
14.5 
21.2 
21.0 
20.5 
20.1 


13.2 
13.2 
17.2 
17.2 
15.3 
15.3 


21.8 
21.5 
21.0 
23.1 
20.5 
19.9 


16.9 
16.9 
16.2 
15.7 
15.0 
13.9 



Typhoid Fever. 

Typhoid fever, according to Sir William Osier, " is everywhere an 
index of the sanitary intelligence of the community." It is encour- 
aging, with this statement in mind, to find that typhoid fever shows ' 
during the six year period under investigation a very large per- 
centage of decrease in its incidence. It is still a cause of much con- 
cern, however, in its wide distribution and in the considerable num- 
ber of deaths that annually result from it. A wide gulf still sepa- 
rates sanitary knowledge from sanitary accomplishment over a large 
area of the United States. It will be possible, through the examina- 
tion of the data of this experience, to determine the comparative 
incidence of the disease in the two color or race groups constituting 
the American working population. This will throw light on the 
different sanitary surroundings of the white and colored people 
respectively. Of perhaps equal interest to the medical profession 
will be the variable incidence of mortality from the disease by sex, 
and in the several main age periods of life. 

Typhoid fever caused 9,011 deaths during the period between 
1911 and 1916. The rate of mortality was 16.8 per 100,000 living, 
the disease accounting for 1.4 per cent, of all the deaths. 

The following table will be the basis of our discussion of the inci- 
dence of the disease in the two race and sex groups according to 
age period : 



TYPHOID FEVER. 



219 



TABLE 140. 

Mortality from Typhoid Fever, Classified by Color, Sex and by Age 

Period. 

Death Bates per 100,000 Persons Exposed. 1911 to 1916. 

Experience of Metropolitan Life Insurance Company. Industrial 
Department. 





Persons. 


White. 


Colored. 


Age Period. 


Males. 


Females. 


Males. 


Females. 


All ages — one and 
over 


16.8 


15.8 


12.8 


35.6 


34.2 






1 to 4 

5 to 9 

10 to 14 

15 to 19 

20 to 24 

25 to 34 

35 to 44 

45 to 54 

55 to 64 

65 to 74 

75 and over. . 


12.7 
12.9 
16.2 
24.6 
23.4 
18.5 
15.1 
13.1 
12.3 
11.8 
10.6 


10.8 
8.6 
12.4 
20.8 
24.3 
20.7 
17.1 
15.1 
15.2 
11.6 
9.9 


11.6 

11.5 

13.4 

20.0 

17.7 

13.2 

10.9 

8.7 

7.5 

7.9 

9.2 


28.8 
41.6 
35.4 
59.5 
46.7 
29.3 
26.4 
28.7 
27.6 
48.4 


35.5 
44.8 
58.4 
60.0 
38.8 
28.8 
20.7 
20.2 
22.0 
20.0 
36.3 



It is evident that typhoid fever death rates show very pronounced 
differences for the two races. Those for the colored persons are 
greatly in excess of those for whites. This holds true for every 
year of the six year period. The rate for colored males (35.6) is 
considerably more than double that for white males (15.8) ; that for 
colored females (34.2) is almost three times that for white females 
(12.8). These differences between the races are even more marked 
when we consider certain of the age periods, especially the years of 
childhood. Thus, between the ages of five and nine, the colored 
children show rates between four and five times as high as those for 
white children at the same ages. It is impossible from the above 
data to say definitely to what extent these race differences indicate a 
varying degree of resistance to the disease. A much more plausible 
explanation is that the great body of the colored policyholders reside 
in those areas of the country and in certain definite localities of 
cities where typhoid fever is much more prevalent than in areas 
inhabited by the white policyholders. It is possible, of course, that 
the factor of resistance plays a part also, but this can be determined 
only by future research which will take into consideration all of the 
local sanitary surroundings of the two races. 



220 



MORTALITY STATISTICS OF INSURED WAGE EARNERS. 



The variations in the incidence of typhoid fever mortality in the 
two sexes are less pronounced, but are, nevertheless, in evidence. 
Taking all ages together, males show higher rates than females, the 
differences being more marked among the whites than among the 
colored. On further analysis, we find that this difference results 
from a considerably higher death rate among males beginning with 
the age period 20 to 24, the male excess increasing with advancing 
age. In the earlier ages, that is, under age 15, there is a pronounced 
excess in the rate of females of both races. 

Eeference has already been made to the varying incidence by age 
in this condition. We may summarize the facts as follows : the 
highest mortality occurs in the age group 15 to 19 years, although 
among white males, this maximum figure is attained in the next age 
period, 20 to 24 years. 

TABLE 141. , 

Mortality from Typhoid Fever. 

Death Bates per 100,000 Persons Exposed. Classified by Sex and Age 
Periods. Insured White Lives in Experience of Metropolitan Life In- 
surance Company, Industrial Department {1911 to 1916) and 
General Population of Expanding Registration Area of 
the United States (1910 to 1915). 





Males. 




Females. 




Age Period. 


M. L. I. Co. 
(Wliite). 


U. S. Reg. 
Area. 


Per Cent. 
M. L. I. Co. 
of Reg. Area. 


M. L. I. Co. 
(White). 


U. S. Reg. 
Area. 


Per Cent. 
M. L. I. Co. 
of Reg. Area. 


All ages — one 
and over . . . . 


15.8 


20.7 


76.3 


12.8 


14.7 


87.1 


lto4.... 


10.8 


10.1 


106.9 


11.6 


10.0 


116.0 


5 to 9 ... . 


8.6 


11.0 


78.2 


11.5 


12.3 


93.5 


10 to 14... 


12.4 


12.7 


97.6 


13.4 


15.7 


85.4 


15 to 19... 


20.S 


26.6 


78.2 


20.0 


22.9 


87.3 


20 to 24... 


24.3 


34.2 


71.1 


17.7 


21.0 


84.3 


25 to 34. . . 


20.7 


27.5 


75.3 


13.2 


15.2 


86.8 


35 to 44... 


17.1 


21.3 


80.3 


10.9 


12.4 


87.9 


45 to 54... 


15.1 


18.3 


82.5 


8.7 


11.8 


73.7 


55 to 64... 


15.2 


18.0 


84.4 


7.5 


11.3 


66.4 


65 to 74... 


11.6 


15.2 


76.3 


7.9 


12.1 


65.3 


75 and over 


9.9 


10.3 


96.1 


9.2 


10.0 


92.0 



A comparison of the above data with those for the population of 
the Eegistration Area of the United States confirms the several 
important relations which have been described. We find again a 
higher incidence of the condition among males than among females 
at all ages combined, and more especially in the ages after early 



TYPHOID FEVER. 221 

adolescence. We find also that the periods of maximum mortality 
are in exact agreement in the two experiences. Among males in the 
Eegistration Area for example, the highest death rate for any period 
is that for the age group 20 to 24 years and, for females, in the 
period 15 to 19 years. The same general contour of the curves of 
mortality by age period for each of the two sexes is to be noted, that 
is, a maximum mortality in the period of early adult life tapering 
down to a minimum at the two extremes of life. 

The table on page 220 presents a comparison of the death rate 
by age and sex for insured lives with corresponding figures for the 
population of the Eegistration Area. 

The general correspondence between the two sets of figures is very 
marked and yet there are important differences to which reference 
should be made. Beginning with the period 5 to 9 years, the 
rates are uniformly higher for the population of the Eegistration 
Area, the most marked difference being found in the age period 20 
to 24 years. For each sex there is a decided advantage, apparently, 
in favor of the insured white lives as compared with the general 
population. It is undoubtedly true that the Eegistration Area 
figures are somewhat higher because of their inclusion of a small 
proportion of colored lives, but perhaps a more significant factor is 
the fact that a large proportion of the population of the Eegistration 
Area is rural in character whereas, the insured lives are almost 
entirely limited to cities and their immediate environment where 
typhoid fever rates are nearly always lower than in the country. 
On the other hand, it should not be overlooked that a considerable 
proportion of the policyholders of the Company reside in certain of 
the non-registration States of the country where typhoid fever is 
more prevalent than in those States which constitute the Eegistra- 
tion Area. All things considered, typhoid fever is not as favorable 
a condition for purposes of comparison as are some others. The 
figures submitted do, however, confirm the essential relations of the 
disease in both groups and serve to show that wage earners and their 
families do not suffer unduly from its effects. 

The decreasing death rate from typhoid fever is one of the very 
gratifying features of this mortality experience. There was a con- 
tinuous and marked decrease in the mortality rate year by year, 
beginning with 1911 and closing with 1915. A slight increase is in 
evidence for 1916 as compared with 1915, but the significance of 



222 



MOETALITY STATISTICS OF INSURED WAGE EAENEES. 



this cannot be evaluated at this time. The following table gives the 
figures for each of the six years in the period by sex and by color : 

TABLE 142. 

Mortality from Typhoid Fever, Classified by Color and by Sex. 

Death Bates per 100,000 Persons Exposed. Single Years in Period 1911 

to 1916. 

Experience of Metropolitan Life Insurance Company. Industrial 
Department, 





Persons. 


White., 


Colored. 




Males. 


Females. 


Males. 


Females. 


1911tol916 


16.8 


15.8 


12.8 


35.6 


34.2 


1916 

1915 

1914 

1913 

1912 

1911 


13.0 
12.9 
16.1 
18.4 
19.1 
22.8 


12.1 
12.1 
15.5 
17.7 
17.9 
21.2 


10.1 

9.8 
12.1 
14.2 
14.6 
17.7 


27.1 
31.8 
35.5 
38.0 
37.5 
45.8 


28.0 
25.4 
31.5 
35.5 
40.5 
46.5 



A comparison of the above figures with those for the Eegistration 
Area shows a number of coincidences. The rate for 1911 in the 
Registration Area was also the highest for the quinquennium 1911 
to 1916; that for 1915 was the lowest for the same period. Again, 
a slight rise is shown for 1916 over 1915 in the population data. In 
other words, the fluctuations in the insurance experience serve here 
as a very sensitive index of the fluctuations in the general popula- 
tion experience. 

Mortality from Sequelae of Typhoid Fever. 

Before closing this section, it will be well to refer to one additional 
feature of typhoid mortality which the data under consideration 
make possible, namely the sequelae of typhoid fever. A study made 
in 1914* of a group of more than 1,000 persons who had recovered 
from an attack of typhoid fever in 1911 showed clearly that in the 
three year period following the disease the mortality was slightly 
more than double what might be normally expected from persons in 
the same age and sex classes. It was found that during the first year 
after recovery close to three times the expected number of deaths 

* Dublin, Louis I., * ' Typhoid Fever and Its Sequelae, ' ' Metropolitan Life 
Insurance Company, 1914, 



CIRRHOSIS OF THE LIVER. 22? 

occurred (384 per cent). During the second year, the ratio of 
actual to expected mortality was 217 per cent, and, during the third 
year, the ratio was only 80 per cent. This would indicate that the 
effect of an attack of typhoid fever continues over a period of two 
years, during which time there is a marked increase in the mortality 
from certain conditions which apparently are induced by typhoid 
fever. These are tuberculosis, diseases of the heart, and diseases of 
the kidney, which all appear in exaggerated proportions as causes 
of death in the group of survivors. 

In considering typhoid mortality, therefore, it is well to remember 
that, in addition to the death rate from the disease, there is also the 
added element of impairment which follows in the track of recovered 
cases, taking a toll of approximately double mortality during the 
period of from two to three years after "recovery" from typhoid 
fever. It is estimated that in the period from 1911 to 1916, when 
9,011 deaths from typhoid fever occurred in the Industrial experi- 
ence of the Metropolitan Life Insurance Company, an additional 
3,600 deaths occurred among those who had been attacked by ty- 
phoid fever but who had recovered — evidently a significant addi- 
tion to the mortality due to any cause of death. 

Cirrhosis of the Liver. 

Eight thousand and sixty-four (8,064) deaths of Metropolitan 
policyholders were recorded as due to cirrhosis of the liver during 
the six year period 1911 to 1916. The death rate was 15.0 per 
100,000 exposed. Included under this title are deaths from alcoholic 
cirrhosis, but not those in which the disease is definitely reported as 
a sequela of syphilis. Alcoholism is recognized as the chief cause of 
cirrhosis of the liver. It must be clear, therefore, that a large num- 
ber of cases of alcoholism are not reported in the published statistics 
where cirrhosis of the liver is registered as the cause of death. All 
statistics in any way related to mortality from alcoholism are still 
understatements. 

Color, Sex and Age Incidence of Mortality from Cirrhosis of the 

Liver. 

The death rate for white policyholders was higher than that for 
colored policyholders for each sex group. This applies to the four 
ten-year age periods of heaviest mortality from the disease extend- 



224 MORTALITY STATISTICS OF INSURED WAGE EARNERS. 

ing from age 35 to age 75. After age 75, the rate for white males 
was also higher than for colored males, but, among females, the 
color relation was reversed. This may well be due to the unre- 
liability of the data for colored females at this advanced age period 
of life. The following table presents the facts by color, sex and 
by age: 

TABLE 143. 

Mortality from Cirrhosis of the Liver, Classified by Color, Sex and 

BY Age Period. 

Death Bates per 100,000 Persons Exposed. 1911 to 1916. 

Experience of Metropolitan Life Insurance Company. Industrial 
Department. 





Persons. 


White. 


Colored. 


Age Period. 


Males. 


Females. 


Males. 


Females. 


All ages — one and 
over 


15.0 


20.7 


10.6 


18.8 


9.6 


1 to 19 

20 to 24 

25 to 34 

35 to 44 

45 to 54 

55 to 64 

65 to 74 

75 and over. . 


.4 

1.0 

6.7 

24.4 

48.8 

66.8 

98.6 

102.8 


.4 

1.1 

9.8 

39.9 

87.8 

114.8 

145.7 

124.8 


.3 
.4 
4.1 
16.5 
29.0 
40.6 
71.3 
91.2 


1.2 
3.3 
10.7 
28.6 
47.6 
73.8 
111.9 
82.3 


1.3 
2.4 
5.3 
11.1 
22.2 
27.7 
64.6 
99.8 



The rates are also much higher for males than for females. This 
applies to both white and colored policyholders at all of the signifi- 
cant age periods. The mortality is low in early life. Beginning 
with the age period 25 to 34 years, the rate becomes important, and, 
after that, rises rapidly, reaching the maximum, for significant age 
groups, at the period of 65 to 74 years. Both white and colored 
males show a decrease in the death rate after age 75, while females 
of both races show significant increases in the rate. It is possible 
that these variations are accidental as the result of the small num- 
ber of lives exposed at the advanced periods of life. 



Comparison of Mortality from Cirrhosis of Liver among Insured 

Wage Earners 1911 to 1916 and among the Population of the 

Expanding Registration Area, 1910 to 1915. 

Comparison with available data by sex and age for the expanding 
Eegistration Area shows that the mortality among insured white 



CIRRHOSIS OF THE LIVER. 



225 



males exceeds very slightly that for the males of the general 
population (20.7 per 100,000 exposed as compared with 18.0 per 
100,000 population). For the females, the corresponding rates are 
10.6 and 8.9. In each experience, it will be noted that the mortality 
among males is about double that among females. As might be 
expected, the death rates for the lower age periods are not signifi- 
cant in either experience. It is not until age 35 is reached that 
cirrhosis of the liver becomes a serious factor in mortality. From 
that age on, the death rate for cirrhosis of the liver is very much 
higher among white insured men and women than it is in the 
Registration Area. At the age period 35 to 44 years, for males, the 
death rate for the policyholders is 39.9 as compared with 19.2 for 
males of the general population. For those 45 to 54 years of age, 
the corresponding rates are 87.8 and 44.1. While the excess is 
smaller in the three highest age groups, it is, nevertheless, very pro- 
nounced in each case. For the females, practically the same rela- 
tions are in evidence, although the rates are lower. In each age 
period, there is found a markedly higher rate among the Industrial 
policyholders. It is believed that in the case of cirrhosis of the 
liver, as with many other diseases in which the death rates for the 
insured exceed those of the general population, the explanation is 



TABLE 144. 

Mortality from Cirrhosis of the Liver, 

Death Rates per 100,000 Persons Exposed. Classified hy Sex and by Age 
Periods. Insured White Lives in Experience of Metropolitan Life In- 
surance Company, Industrial Department (1911 to 1916) and 
General Population of Expanding Begistration Area of 
the United States (1910 to 1915). 





Males. 


Females. 


Age Period. 


M. L. I. Co. 
(White). 


U. S. Reg. 
Area. 


Per Cent. 
M. L. I. Co. 

of Reg. Area. 


M. L. I. Co. 
(White). 


U. S. Reg. 
Area. 


Per Cent. 
M. L. I. Co. 
of Reg. Area. 


All ages — one 














and over . . . . 


20.7 


18.0 


115.0 


10.6 


8.9 


119.1 


ltol9.... 


.4 


.4 


100.0 


.3 


.4 


75.0 


20 to 24... 


LI 


.9 


122.2 


.4 


.7 


57.1 


25 to 34.... 


9.8 


5.3 


184.9 


4.1 


3.0 


136.7 


35 to 44.... 


39.9 


19.2 


207.8 


16.5 


9.8 


168.4 


45 to 54.... 


87.8 


44.1 


199.1 


29.0 


19.5 


148.7 


55 to 64.... 


114.8 


74.9 


153.3 


40.6 


31.5 


128.9 


65 to 74.... 


145.7 


104.7 


139.2 


71.3 


53.9 


132.3 


75 and over 


124.8 


108.7 


114.8 


91.2 


73.9 


123.4 



226 MORTALITY STATISTICS OF INSURED WAGE EARNERS. 

found in part in the different distribution of the exposure with 
reference to rural and urban residence. Examination of the gen- 
eral population mortality reports, year after year, shows that for this 
disease the urban mortality is in the neighborhood of 50 per cent, in 
excess of the rural. The fact that the insured exposure is almost 
entirely urban in character is undoubtedly an important element in 
their higher death rate. The special circumstances which give rise 
to a higher urban rate for this disease are at present unknown. 

The table on page 225 presents a comparison of the death rates 
for cirrhosis of the liver by age and sex in the general population 
and among the Industrial policyholders. 

Trend of the Death Rate from Cirrhosis of the Liver. 
The highest mortality during the six year period was encountered 
in the year 1912 (16.7) while the lowest was for the year 1916 
(13.6). There were no marked fluctuations in the mortality, 
although the trend in both the Metropolitan experience and that of 
the expanding Eegistration Area was downward. 

Influenza. 

True epidemic influenza is a specific infectious disease. Several 
times within the last two decades of the nineteenth and in the 
second decade of the present century it has been epidemic or en- 
demic in this country, notably in 1889, 1890 and in 1915 and 1916. 
From the statistical standpoint, however, it is still necessary to 
exercise great caution in considering this disease. The word " in- 
fluenza " is a term which is very loosely used by physicians and in 
many cases in which it is given as the cause of death it is in error, 
the true cause being some other condition accompanied with respira- 
tory symptoms. It is very necessary to bear this in mind in com- 
paring the death rate for influenza for a period of years and in fact 
in evaluating the extent of the mortality from the condition at the 
present time. It should not be lost sight of, however, that the 
tendency to use the term correctly is becoming more and more 
marked as the years go on. 

The 8,056 deaths which were ascribed to influenza during the 
period 1911 to 1916 were therefore an over-statement of the num- 
l)er, although it is impossible to determine the element of error. 
The death rate based on this number of deaths was 15.0 per 100,000 



INFLUENZA. 



227 



living. During the six year period the highest rate was for 1916 
(23.8) ; the minimum rate was observed in the year 1914 (11.3). 
The incidence, therefore, more than doubled in a short span of two 
years, showing clearly the epidemic character of the disease. In the 
expanding Eegistration Area of the United States also, much the 
same condition prevailed. The mortality in 1916 reached a rate of 
26.4 per 100,000, Ijy far the highest rate in the history of the United 
States Eegistration Area and exceeding by 65 per cent, the rate for 
the year before. The disease was especially prevalent and virulent 
in various parts of the country during the latter part of 1915 and 
in the early months of 1916, which accounts for the marked increase 
shown in the death rates, both in the reports of the United States 
Census Bureau and in the Industrial experience of the Metropolitan. 
The following table presents the data for each of the six years 
between 1911 and 1916 by color and sex: 

TABLE 145. 

Mortality from Influenza, Classified by CoiiOR and by Sex. 
Death Bates per 100,000 Persons Exposed. Single Years in Period 1911 

to 1916. 

Experience of Metropolitan Life Insurance Company. Industrial 
Department. 





Persons. 


White. 


Colored. 


Year. 














Males. 


Females. 


Males. 


Females. 


1911 to 1916 


15.0 


11.3 


14.0 


26.5 


33.6 


1916 


23.8 


18.7 


24.2 


34.9 


44.1 


1915 


13.0 


9.4 


12.1 


28.3 


29.0 


1914 


11.3 


8.3 


10.7 


20.6 


25.8 


1913 


12.3 


9.4 


11.4 


23.9 


25.9 


1912 


12.3 


8.9 


10.0 


25.5 


35.8 


1911 


15.9 


11.9 


14.2 


25.3 


41.3 



Influenza Mortality According to Color, Sex and Age. 

The mortality from this disease is most prominent at the two 
extremes of life, especially at the older ages when very high death 
rates are attained. The lowest rates are observed between the ages 
5 and 35 years. Prom age 35 onward the incidence rapidly in- 
creases, more than doubling with each successive age period. 

The above facts with regard to age period are generally true for 
both sexes and both races. The death rate for colored policyholders 



228 



MORTALITY STATISTICS OF INSURED WAGE EARNERS. 



is more than double that for white persons for each sex. This dif- 
ference between the two race groups becomes very marked in some 
of the lower age periods, when the rate for the colored is more than 
three times that for the white. 

Females show uniformly higher rates than males in both race 
groups. This is especially marked in the period of middle life and 
of old age when the death rates are highest. The following table 
presents the facts for influenza by color, sex and age period during 

the six year period : 

TABLE 146. 

Mortality from Influenza, Classified by Color, Sex and by Age Period. 

Death Bates per 100,000 Persons Exposed. 1911 to 1916. 

Experience of Metropolitan Life Insurance Company. Industrial 
Department. 





Persona. 


White. 


Colored. 


Age Period. 


Males. 1 Females. 


Males. 


Females. 


AH ages — one and 
■over 


15.0 


11.3 


14.0 


26.5 


33.6 






lto4 

5 to 9 

10 to 14 

15 to 19 

20 to 24 

25 to 34 

35 to 44 

45 to 54 

55 to 64 

65 to 74 

75 and over. . 


13.1 

3.5 

2.4 

3.6 

4.7 

6.7 

11.2 

22.2 

53.9 

'148.0 

315.0 


12.6 

2.9 

1.8 

2.7 

3.4 

5.0 

10.8 

18.9 

44.9 

121.2 

235.5 


11.8 

3.4 

2.2 

2.6 

3.5 

4.7 

7.6 

17.5 

45.7 

142.4 

329.0 


28.8 

7.5 

4.1 

9.3 

10.5 

16.3 

23.8 

40.4 

94.8 

230.5 

397.9 


20.3 

5.8 

8.4 

13.2 

15.3 

15.9 

21.3 

49.7 

124.1 

285.4 

617.0 



That very similar relations in the death rates by sex and age pre- 
vail in the general population of the "United States is shown by the 
data for the expanding Eegistration Area, 1910 to 1915. It will 
not be necessary, however, because of the element of uncertainty in 
the rates for influenza to give the actual figures for the Eegistration 
Area. It should be noted nevertheless that the mortality rates from 
&is condition are much higher among the white urban policy- 
holders than in the population of the Eegistration Area for each 
sex and at virtually every age period. 



DIABETES. 



229 



Diabetes. 

The data on diabetes in this experience of insured wage earners 
are, so far as we can determine, original in the literature of Ameri- 
can vital statistics. In spite of the intense interest of the medical 
profession in the subject in recent years, little has been done so far 
to determine the extent to which the condition is responsible for 
mortality. The figures herein submitted are not only accurate 
measures of the incidence of the disease as a cause of death in gen- 
eral, but, what is perhaps more important, they give a picture of the 
history of the condition in relation to sex, color and age period. To 
the clinician and the laboratory student of the disease, the relations 
presented may well serve as a clue in directing further diabetes 
research. Another element of interest inherent in these figures is 
that, referring, as they do, to the industrial population, they may 
throw light on the probable effect of social and economic condition 
upon the incidence of diabetes. This is still a mooted question in 
the medical literature. There is a tendency in some quarters to re- 
gard the disease as more prevalent among the prosperous elements 
of the population. On the other hand, certain exciting causes in- 
herent in the harsher conditions of life and work have been identi- 
fied in the case-histories of diabetes mellitus. It will be important, 



TABLE 147. 

Mortality from Diabetes, Classified by Color, Sex and by Age Period. 

Death Bates per 100,000 Persons Exposed. 1911 to 1916. 

Experience of Metropolitan Life Insurance Company. Industrial 
Department. 





Persons. 


White. 


Colored. 


Year. 


Males. 


Females. 


Males. 


Females. 


All ages — one and 
over 


14.4 


10.8 


18.5 


9.5 


11.4 






lto4 

5 to 9 

10 to 14 

15 to 19 

20 to 24 

25 to 34 

35 to 44 

45 to 54 

55 to 64 

65 to 74 

75 and over. . 


1.8 

1.7 

3.4 

4.0 

4.0 

5.4 

9.3 

30.4 

80.1 

127.2 

134.9 


1.9 

1.6 

3.1 

4.5 

5.0 

6.5 

10.6 

25.4 

56.6 

95.5 

102.1 


1.9 

1.8 

4.1 

4.0 

3.7 

4.9 

8.8 

34.3 

102.1 

161.4 

158.2 


2.3 

.3 

2.6 

3.3 

4.7 

9.6 

20.8 

48.6 

55.1 

109.8 


1.9 

.6 

2.5 

1.5 

.8 

4.3 

7.7 

33.5 

53.7 

57.5 

108.9 



230 MOETALITY STATISTICS OF INSUEED WAGE EARNERS. 

therefore, to see later how the figures here presented compare in 
detail with those in the general population whose economic status is 
altogether more favorable. If the number of deaths in this ex- 
perience (7,762) are not as many as for other conditions which have 
been discussed, it should be remembered that this number is by far 
the largest aggregation of cases of this disease which have as yet 
received extended statistical treatment. 

The table on page 229 presents the death rates per 100,000 
persons exposed with respect to color, sex and age period. 

The death rate increases with age. Under 35 years, there is no 
very appreciable incidence of the condition. Between ages ten and 
fourteen, a rate of 3.4 deaths per 100,000 persons living is the first 
indication of a significant distribution in the population of the 
disease in its malignant form. Between 25 and 34 years, the rate, 
5.4, accentuates the earlier finding. Beyond 35 years, there is a 
rapid rise in the slope of the curve for diabetes. The highest point 
is observed in the last age period, namely, 75 and over. But, even 
in the more significant age period of 65 to 74 years the rate is not 
far from its maximum. In fact, among white females, the maxi- 
mum is reached in this period. 

There is a lower death rate among colored persons at each of the 
age periods, and this is especially true of colored females as com- 
pared with white females. The difference in favor of colored lives 
becomes more important beyond age 55, when diabetes is an im- 
portant condition. It should be noted also that diabetes has a very 
marked sex incidence, the rates beyond age 45 being for both white 
and colored women higher than for males of the corresponding race. 
There is only one exception and it is not a significant one. Prior 
to age 45, the condition is reversed. This suggests the inter- 
esting question whether the menopause may not have some influence 
in changing the sex ratio of diabetes mortality after 45 years of age. 

Diabetes Mortality Among Insured Wage Earners and Among the 

General Population of the United States {Expanding Registrar 

tion Area) Compared. 

Among males, under 20 years of age, and, among females under 
35 years of age, in this insurance experience, the diabetes death 
rates are, almost without exception, lower than the corresponding 
rates for the population in the Registration Area of the United 



DIABETES. 



231 



States. Beyond 20 years of age, however, there is an excess in the 
rate among insured white males which increases up to the period 35 
to 44, Beyond this age, the ezcess declines to a point where the 
rates for the two groups are much the same. Among the females, 
there are significantly higher rates for insured women than for those 
in the general population. Beginning with the age period 45 to 54 
years, the amount of excess varies somewhat from 25 to 30 per cent. 
The following table presents a comparison for the disease in 
the two series, that is, the insured group and the general Eegistra- 
tion Area population : 

TABLE 148. 
MOETALITY FROM DIABETES. 

Death Bates per 100,000 Persons Exposed. Classified hy Sex and hy Age 
Periods. Insured White Lives in Experience of Metropolitan Life In- 
surance Company, Industrial Department (1911 to 1916) and 
General Population of Expanding Registration Area of 

the United States (1910 to 1915). 





Males. 


Females. 


Age Period. 






Per Cent. 






Per Cent. 




M. L. I. Co. 


U. S. Reg 


M. L. I. Co. 


M. L. I. Co. 


U. S. Reg. 


M. L. 1. Co. 




(White) . 


Area. 


of Reg. Area. 


(White) . 


Area. 


of Reg. Area. 


All ages — one 














and over . . . . 


10.8 


14.5 


74.5 


18.5 


17.5 


105.7 


1 to4.... 


L9 


2.2 


86.4 


1.9 


1.8 


105.6 


5 to 9 ... . 


1.6 


3.0 


53.3 


1.8 


3.0 


60.0 


10 to 14... 


3.1 


4.2 


73.8 


4.1 


4.8 


85.4 


15 to 19... 


4.5 


4.8 


93.8 


4.0 


4.1 


97.6 


20 to 24... 


5.0 


4.8 


104.2 


3.7 


3.8 


97.4 


25 to 34... 


6.5 


5.6 


116.1 


4.9 


5.2 


94.2 


35 to 44... 


10.6 


8.6 


123.3 


8.8 


8.3 


106.0 


45 to 54... 


25.4 


22.6 


112.4 


34.3 


27.5 


124.7 


55 to 64... 


56.6 


57.4 


98.6 


102.1 


78.4 


130.2 


65 to 74... 


95.5 


95.0 


100.5 


161.4 


127.9 


126.2 


75 and over 


102.1 


112.8 


90.5 


158.2 


121.2 


130.5 



Trend of the Death Rate from Diabetes. 

In this experience for insured wage earners, there is a slight 
tendency toward increase in the recorded death rate for diabetes 
mellitus There is some significance attached to this increase in 
mortality from the disease. There are no important nosologic con- 
siderations confusing the statistics for diabetes as was observed for 
several other diseases and conditions, notably, cancer. Fatal dia- 
betes is well reported in this mortality experience and the certifica- 



232 



MORTALITY STATISTICS OF INSURED WAGE EARNERS. 



tion of the disease has probably not improved materially during the 
period covered by this experience. The minimum rate was observed 
in 1911, 13.3 per 100,000 persons exposed. The group of insured 
white females, as in other years, was very largely responsible for the 
high figure shown in 1916 for the entire experience. In 1911, in- 
sured white females registered a diabetes rate of 16.5 per 100,000 
exposed; in 1916, the figure was 20.2 per 100,000. 

In the experience of the Eegistration Area of the United States, 
there has been also observed since 1900 a gradual increase in the 
death rate of diabetes mellitus. 

The figures for the individual years are shown herewith by color 
and sex : 

TABLE 149. 
MORTALITT rROM DIABETES, CLASSIFIED BY COLOR AND BY SeX. 

Death Bates per 100,000 Persons Exposed. Single Years in Period 1911 

to 1916. 

Experience of Metropolitan Life Insurance Company. Industrial 
Department. 







White. 


Colored. 


Year. 


Persons. 


Males. 


Females. 


Males. 


Females. 


1911 to 1916 


14.4 


10.8 


18.5 


9.5 


11.4 


1916 

1915 

1914 

1913 

1912 

1911 


15.9 
15.1 
14.2 
13.9 
13.7 
13.3 


11.5 
10.3 
10.5 
10.8 
10.3 
11.3 


20.2 
20.0 
18.4 
17.5 
17.7 
16.5 


11.6 
8.1 

10.0 
8.9 
9.7 
8.1 


14.8 
14.4 
10.4 
10.9 
9.2 
7.7 



CHAPTER XT. 

This chapter will deal with the following diseases: 

(1) Appendicitis. 

~ (2) Hernia, Intestinal Obstruction. 

(3) Syphilis. 

(4) Chronic Bronchitis. 

(5) Rheumatism. 

(6) Acute Bronchitis. 

(7) Alcoholism, Acute and Chronic. 

Appendicitis. 

Interest attaches to the statistical treatment of appendicitis in 
view of the increased accuracy of the returns in recent years for this 
condition. Many deaths are now classed properly as due to appen- 
dicitis which some years ago would have been charged to "peri- 
tonitis." Fortunately, the many deaths classified as due to appen- 
dicitis in this experience covered a period during which every effort 
was made to assign these deaths to their proper cause. 

The total number of deaths from appendicitis during the period 
1911 to 1916 was 6,345, corresponding to a death rate of 11.8 per 
100,000 exposed. The death rate for colored insured persons is 
slightly higher than that for white lives. This is true for each 
sex, although the difference between colored females and white 
females is the more marked. The rate for males is slightly higher 
than for females among both white and colored policyholders. A 
more careful examination of the mortality curve shows some very 
interesting characteristics by age period. Thus, the age period of 
maximum incidence is at 15 to 19 years. This is true, with the 
exception of the white female group, for each one of the race and 
sex categories in this experience. From this age period onward, 
txie rates decline for a period of twenty-five to thirty-five years. 
The rates then increase somewhat only to decline again. The sug- 

233 



234 



MORTALITY STATISTICS OF INSURED WAGE EARNERS. 



gestion of Stouman* that the curve of mortality for this disease 
is, in fact, a combination of two curves, both skew, appears to be 
confirmed by our figures. Only additional medical research can 
clear up the true meaning of this characteristic. 

The following table presents the death rates for appendicitis by 
color, sex and age period : 



TABLE 150. 

MOKTAIilTY FROM APPENDICITIS, CLASSIFIED BY COLOE, SeX AND BY AGE PeEIOD. 

Death Bates per 100,000 Persons Exposed. 1911 to 1916. 
Experience of Metropolitan Life Insurance Company. Industrial Department. 





Persons. 


White. 


Colored. 


Age Period. 


Males. 


Females. 


Males. 


Females. 


An ages — one and 
over 


11.8 


13.2 


10.2 


13.9 


12.8 


lto4 

5 to 9 

10 to 14 

15 to 19 

20 to 24 

25 to 34 

35 to 44 

45 to 54 

55 to 64 

65 to 74 

75 and over. . 


4.7 
10.1 
13.9 
15.7 
12.9 
12.4 
11.6 
11.8 
11.3 
10.8 
11.0 


4.8 
10.6 
15.6 
18.3 
15.6 
13.6 
13.2 
12.4 
14.2 
13.3 
17.0 


4.8 
9.9 

12.6 

12.4 
9.9 

10.9 
9.3 

11.1 
9.4 
9.2 
9.2 


5.8 
9.7 
15.8 
18.5 
14.1 
13.5 
14.4 
16.3 
12.0 
13.4 


.6 

7.0 

9.0 

19.0 

15.9 

15.0 

15.8 

10.2 

11.0 

9.4 



There are no pronounced differences between the death rates of 
the Industrial experience and those for the Eegistration Area of 
the United States when considered by sex and age period. The 
characteristics above described are observed also in the population 
data. 

The death rates for the individual years between 1911 and 1916 
do not show any definite tendency toward increase or decrease. 
The figures for white males on their own account would indicate a 
condition of slight increase; for white females there is very little 
variation, while for colored males there is a slight decrease. The 
rates for colored females vary too markedly from year to year to 
permit any conclusion to be drawn. The facts are shown m the 
following table: 

* Stouman, Knud, "An Analysis of Appendicitis Statistics," American 
Journal of Public Health, Vol. 6, July, 1916. 



HEENIA AND INTESTINAL OBSTRUCTION. 236 

TABLE 151. 

Mortality from Appendicitis, Classified by Color and by Sex. 

Death Bates per 100,000 Persons Exposed. Single Years in 
Period 1911 to 1916. 



Experience of Metropolitan Life Insurance Company. 


Industrial 


Department. 




Persons. 


White. 


Colored. 


Year. 


Males. 


Females. 


Males. 


Females. 


1911 to 1916 


11.8 


13.2 


10.2 


13.9 


12.8 


1916 

1915 

1914 

1913 

1912 

1911 


12.3 
11.8 
12.0 
12.0 
11.5 
10.9 


14.2 
13.3 
13.5 
13.7 
12.1 
12.2 


10.0 
10.1 
10.7 
10.1 
10.6 
9.6 


13.1 
15.6 
12.1 
13.5 
14.7 
14.1 


16.8 
11.7 
12.6 
14.3 
11.6 
9.7 



Heenia and Intestinal Obsteuction. 

Hernia and intestinal obstruction caused 5,519 deaths among 
Metropolitan policyholders during the period 1911 to 1916. The 
death rate was 10.3 per 100,000 exposed. Of these deaths, 2,357 
were caused by hernia with a rate of 4.4 and 3,162 by intestinal 
obstruction with a rate of 5.9. 



Color, Sex and Age Incidence. 

Considering the conditions jointly, the mortality is found to be 
higher among colored policyholders than among white policyhold- 
ers; the death rate for colored males is 12.4 per 100,000 exposed, 
as compared with 8.5 for white males; that for colored females is 
12.2 as compared with 11.2 for white females. Among white poli- 
cyholders the mortality among females is higher than that among 
males. The highest rates occur among the higher age groups, the 
maximum being for the period 75 years and over. It is significant 
that the rate for the lowest age period, 1 to 4 years, is higher than 
the rates for the succeeding age periods up to age 35. There is 
considerable difference, however, in the color incidence of the dis- 
ease in the different age groups. Among white males, the rates 
for the first five age periods, that is, up to age 24, are higher than 
the corresponding rates for females. In the periods from 25 to 74 
years the males have decidedly lower rates. For ages 75 and over 
the male rate is asrain in excess of the female rate. Colored males 



236 



MORTALITY STATISTICS OF INSURED WAGE EARNERS. 



show rates in excess of those for colored females for the first four 
age periods, from 1 to 20 years. From 24 to 54 years the female 
rates are higher. For the age period 55 to 64 and 65 to 74, the 
male rate is about double that for females ; while for the group 75 
years and over the male rate is about four times the female rate. 
These facts are presented in the following table : 

TABLE 152. 

Mortality feom Hernia and Intestinal Obstruction, Classified by 
Color, Sex and by Age Period. 

Death Bates i)er 100,000 Persons Exposed. 1911 to 1916. 

Experience of Metropolitan Life Insurance Company. Industrial Department. 





Persona. 


White. 


Colored. 


Age Period. 


Males. 


Females. 


Males. 


Females. 


All ages — one and 
over 


10.3 


8.5 


11.2 


12.4 


12 2 






1 to4 

5 to 9 

10 to 14 

15 to 19 

20 to 24 

25 to 34 

35 to 44 

45 to 54 

55 to 64 

65 to 74 

75 and over. . 


7.7 

2.3 

1.5 

2.3 

3.2 

5.4 

10.2 

20.6 

40.4 

75.5 

145.0 


9.6 

2.6 

2.0 

2.4 

3.4 

4.3 

7.0 

17.9 

34.7 

70.9 

160.3 


5.6 

1.6 

.9 

1.6 

2.5 

4.6 

10.9 

22.4 

44.7 

81.9 

141.5 


9.6 

5.2 

3.2 

5.8 

4.9 

8.0 

10.2 

17.9 

51.0 

83.5 

205.8 


8.9 

2.9 

1.6 

4.4 

5.0 

11.8 

16.8 

21.2 

28.2 

41.1 

45.4 



Trend of the Death Rate from Hernia and Intestinal Obstruction. 

The general tendency during the period has been toward a lower 
death rate from these causes. The highest rate was that for 1911 
(11.0), the lowest that for 1915 (9.6). The rate increased in 1916 
to 10.1. Compared with the experience in the Eegistration Area 
it will be noted that the rates for the two conditions combined were 
higher for each year in the Eegistration Area than for the Indus- 
trial policyholders of the Company. A closer analysis, however, 
shows that this was due to a much higher mortality in the Area 
for intestinal obstruction, which is common among children under 
one year of age. Since there are no Industrial policyholders at 
this earliest age period, the rate for the Company's experience is 
not affected by this high mortality from intestinal obstruction. 



SYPHILIS. 237 



Syphilis. 



Syphilis as the chief and determining cause of death was returned 
in 4,659 cases in the Industrial experience of the Metropolitan Life 
Insurance Company during the six year period 1911 to 1916. This 
figure corresponds to a death rate of 8.7 per 100,000 living. 

In common with other statistical returns on this condition, these 
figures represent an utterly inadequate measure of its true inci- 
dence. In fact, the statistical discussion of the mortality from 
syphilis is still subject to the gravest reservations because of the 
tendency of physicians to conceal this disease in their reports of 
causes of death. A wide gap separates the meager returns of mor- 
tality compilations from what clinicians know to be the wide dis- 
tribution and the serious consequences of syphilitic infection. 
Nevertheless, the data at our disposal are worthy of consideration, 
if only because they show an unmistakable tendency in the direc- 
tion of more accurate certification of this cause of death. A com- 
parison of the rate for the year 1916 in this Industrial experience 
with that for 1911 would, in itself, indicate a most alarming in- 
crease. Thus, in the first year, the figure is 3.4 per 100,000 and, 
in the last year, 11.9. The apparent rate has more than trebled 
in the short period of six years. The truth is, however, that each 
year more effort was expended in identifying suspicious reports as 
true cases of syphilis. For years to come, the published death rates 
for syphilis are certain to increase; but many years will elapse be- 
fore the mortality figures will present an approximate picture of 
the ravages of this disease. 

Fundamentally, the statistics of syphilis suffer from a defect in 
the system of classification. Conditions clinically known as due to 
syphilis, such as locomotor ataxia, general paralysis of the insane, 
and certain cardiovascular, renal and hepatic affections can not, as 
yet, be assigned to this cause because of the prevailing rules of 
international compiling practice. For the time being and until 
the International List of Causes of Death is revised, these diseases 
must continue to be assigned to conditions of various local tracts, 
and not to the general disease, syphilis, which classification present 
medical knowledge demands. Combining syphilis, locomotor ataxia 
and general paralysis of the insane, there would be not 4,659 deaths 
from syphilis in this experience, but a total of 7,680. The com- 
bined death rate is thus raised to 14.3 per 100,000; but even this 



238 



MORTALITY STATISTICS OF INSURED WAGE EARNERS. 



figure is far from the truth when we consider the large number of 
fatal cases of true syphilis which are reported as due to cirrhosis 
of the liver, aneurism, myelitis, cerebral tumor, and others. It is 
hoped that the future will clear up the uncertainty and indefinite- 
ness which still affect our statistical knowledge of syphilis mor- 
tality. 

The following tables show first, the mortality incidence by color 
and sex of syphilis, definitely so reported or identified, and second, 
for the group — syphilis, locomotor ataxia and general paralysis of 
the insane combined. Distinction is made for the individual years 
between 1911 and 1916 in both tables. 



TABLE 153. 

MOKTAIiITT FEOM SYPHILIS, CLASSIFIED BY COLOE AND BY SEX. 

Death Bates per 100,000 Persons Exposed. Single Years in 

Period 1911 to 1916. 

Experience of Metropolitan Life Insurance Company. Industrial Department. 





Persons. 


White. 


Colored. 


Year. 


Males. 


Females. 


Males. 


Females. 


1911 to 1916 


8.7 


9.3 


3.9 


32.4 


18.7 


1916 

1915 

1914 

1913 

1912 

1911 


11.9 
11.4 
9.8 
6.0 
8.1 
3.4 


13.2 

12.2 

10.8 

5.9 

8.8 

3.0 


5.2 
5.4 
4.2 
2.7 
3.8 
1.5 


47.1 
44.8 
37.8 
21.5 
25.3 
13.9 


24.6 
22.4 
20.2 
16.1 
18.2 
9.5 



TABLE 154. 

Mortality fbom Syphilis, Locomotor Ataxia and General Paralysis of 

THE Insane, Combined, Classified by Color and by Sex. 

Death Bates per 100,000 Persons Exposed. Single Years in 

Period 1911 to 1916. 

Experience of Metropolitan Life Insurance Company. Industrial Department. 







White. 


Colored. 


Year. Persona. 


Males. 


Females. 


Males. 


Females. 


1911 to 1916 


14.3 


16.6 


7.3 


43.3 


25.2 


1916 

1915 

1914 

1913 

1912 

1911 


15.7 
16.0 
14.6 
13.7 
13.7 
11.0 


17.7 
17.9 
16.9 
16.5 
16.2 
13.8 


7.6 

8.5 
7.2 
6.9 
7.4 
6.1 


55.3 
55.0 
47.8 
37.0 
35.3 
25.9 


30.6 
27.1 
26.7 
25.4 
24.6 
15.7 



SYPHILIS. 



239 



Even these tables, defective as they undoubtedly are, serve to 
indicate some important relations (of syphilis mortality) in the 
several color and sex classes. The death rate among colored lives 
is consistently higher than among whites. The rates are about 
three to one. The rates are much higher for males than for females 
in each one of the color groups. If we consider the figures for 
1916, we will find a death rate of 55.3 for all ages combined for 
colored males. This is a mortality figure which must be consid- 
ered seriously, because it is higher than the rate for many other 
causes of death which are viewed with much alarm. More inter- 
esting relations, however, are brought out in the two following 
tables which give the death rates by age period both for syphilis so 
reported or identified, and for syphilis combined with locomotor 
ataxia and general paralysis of the insane. 

TABLE 155. 

Mortality from Syphilis, Classified by Color, Sex and by Age Period. 

Death Bates per 100,000 Persons Exposed. 1911 to 1916. 
Experience of Metropolitan Life Insurance Company. Industrial Department. 





Persona. 


White. 


Colored. 


Age Period. 


Males. 


Females. 


Males. 


Females. 


All ages — one and 
over 


8.7 


9.3 


3.9 


32.4 


18.7 






lto4 

5 to 9 

10 to 14 

15 to 19 

20 to 24 

25 to 34 

35 to 44 

45 to 54 

55 to 64 

65 to 74 

75 and over. . 


2.6 

.6 

.6 

1.3 

3.3 

10.2 

22.0 

24.1 

20.1 

15.3 

13.0 


2.0 

.5 

.6 

.7 

2.6 

10.4 

29.8 

34.9 

28.5 

21.0 

22.7 


1.4 

.4 

.3 

.9 

1.6 

4.2 

9.0 

10.1 

8.3 

7.0 

4.2 


12.8 

2.3 

3.2 

4.2 

11.8 

35.2 

60.8 

71.0 

74.4 

60.1 

54.9 


14.6 

2.6 

1.6 

7.0 

12.4 

21.3 

31.3 

33.0 

26.8 

24.7 

18.1 



A comparison of Tables 155 and 156 shows, as might be ex- 
pected, that for the earlier age periods no significant changes in the 
rates are caused by combining deaths reported from syphilis with 
those reported as due to locomotor ataxia and general paralysis of 
the insane. In the age groups which cover middle and old age, 
however, the death rates are raised very materially by the addition 
of deaths certified as due to these other causes but which are caused. 



240 



MORTALITY STATISTICS OF INSURED WAGE EARNERS. 



TABLE 156. 

Mortality from Syphilis, Locomotor Ataxia and General Paralysis op 

THE Insane, Combined, Classified by Color, Sex and by 

Age Period. 

Death Bates per 100,000 Persons Exposed. 1911 to 1916. 

Experience of Metropolitan Life Insurance Company. Industrial Department. 





Persona. 


White. 


Colored. 


Age Period. 


Males. 


Females. 


Males. 


Females. 


All ages — one and 
over 


14.3 


16.6 


7.3 


43.3 


25.2 


1 to4 

5 to 9 

10 to 14 

15 to 19 

20 to 24 

25 to 34 

35 to 44 

45 to 54 

55 to 64 

65 to 74 

75 and over. . 


2.6 

.7 

.7 

1.4 

3.5 

12.6 

32.9 

41.6 

43.6 

49.8 

74.9 


2.0 
.6 

.7 

.9 

2.7 

13.8 

48.2 

65.0 

64.0 

65.1 

112.1 


1.4 

:t 

1.0 
1.7 
5.5 
14.2 
18.2 
21.7 
32.2 
51.9 


12.8 

2.3 

3.2 

4.8 

12.5 

38.9 

79.8 

102.9 

117.1 

120.3 

137.2 


14.6 

2.6 

1.6 

7.0 

12.4 

24.3 

40.6 

48.7 

51.9 

66.9 

45.4 



primarily, by S3rphilitie infection. The figures for the first age 
period, 1 to 4 years, do not constitute an adequate illustration of 
the well known fact that syphilis causes a very high mortality in 
early childhood. This experience does not cover the mortality of 
the first year of life; if it did the figures would be many times 
higher. After the first age group there is a decrease, but beginning 
with the period 15 to 19 years there is a continuous increase 
throughout the period of middle and old age. This continuous 
increase is shown, with one or two minor exceptions, for both males 
and females among white and colored policyholders. Attention is 
directed to the extremely high figures representing the mortality 
from syphilis among colored males at the period between 45 and 
65 years. 

No reference is made here to the figures for the Eegistration Area 
because of the dissimilarity in the two experiences with respect to 
reporting practice, age and color factors. Syphilis is very common 
as a cause of death in the first year of life and this infant mortality 
finds no place in the insurance experience. The situation is further 
complicated by the uncertainty of the returns in the published mor- 
tality figures for the Eegistration Area and nothing can be gained 
by further comparison. 



CHEONIC BRONCHITIS. 



241 



Cheonic Beonchitis. 

Chronic bronchitis caused 4,224 deaths among Metropolitan In- 
dustrial policyholders during the six-year period 1911 to 1916 ; the 
death rate per 100,000 living was 7.9. This rate is much higher 
than that for acute bronchitis in the same experience, which is con- 
trary to the condition found in the expanding Registration Area of 
the United States. The difference is clearly due to the differing 
age distribution of the two populations. 

The disease has a marked color, sex and age incidence. The 
rates among colored persons are higher than among the white 
group for each of the two sexes. The highest mortality is attained 
in the latest age periods in this series, namely, 65 years and over, 
although the rates between 55 and 64 years are also significant. 
Unlike acute bronchitis, there is no high mortality in the earliest 
age periods of life. It is noteworthy also that the excess pointed 
out for colored lives does not continue into the advanced ages. 
From age 65 onward, the rates for white males and females are 
much in excess. It is not clear just what this reversal of the inci- 
dence in the two races indicates. 

The following table presents the facts for chronic bronchitis by 
color, sex and age : 

TABLE 157. 
MOETALITY FEOM CHRONIC BRONCHITIS, CLASSIFIED BY COLOR, SeX AND BT 

Age Period. 

Death Bates per 100,000 Persons Exposed. 1911 to 1916. 

Experience of Metropolitan Life Insurance Company, Industrial Department. 





Persons. 


White. 1 Colored. 


Age Period. 


Males. 


Females. Males. 


Females. 


All ages — one and 
over 


7.9 


6.8 


8.1 


9.4 


11 4 






lto4 

5 to 9 

10 to 14 

15 to 19 

20 to 24 

25 to 34 

35 to 44 

45 to 54 

55 to 64 

65 to 74 

75 and over. . 


1.7 

.9 

.5 

.9 

1.7 

2.4 

3.6 

9.1 

29.5 

113.2 

304.4 


1.4 

.7 

.2 

.3 

1.1 

1.7 

4.0 

10.8 

32.1 

111.4 

309.3 


1.2 

.8 

.4 

.5 

.6 

1.2 

2.3 

6.6 

27.3 

120.3 

317.3 


6.4 

1.9 

2.2 

2.9 

5.3 

7.0 

6.2 

17.9 

28.2 

85.2 

150.9 


7.6 

3.2 

1.9 

7.3 

9.5 

7.9 

7.3 

11.3 

34.3 

82.2 

235.9 



17 



242 MORTALITY STATISTICS OF INSURED WAGE EARNERS. 

As in the case of acute bronchitis, we are not justified in compar- 
ing the above figures with those for the expanding Eegistration Area 
of the United States. The rates, as we have seen, are important 
only after age 65, and it is at these ages that the proportion of 
policyholders to total persons insured is much lower than in the 
general population. 

There has been a marked decline in the death rate in the insur- 
ance experience from chronic bronchitis since 1911 in each one of 
the color and sex classes. The same condition is to be observed 
in the figures for the expanding Registration Area. It is probable 
that the same cause has been at work to bring about this result, 
namely, improved reporting of causes of death by physicians. 
Many vital statistics offices in the country have for a number of 
years made a special effort to advise physicians against the use of 
the term "chronic bronchitis" when tuberculous bronchitis was 
meant. Undoubtedly the effect of this effort is shown in the rap- 
idly reducing figures for this cause of death. 

Rheumatism. 

Deaths from rheumatism are classified, according to the detailed 
International List of Causes of Death, under two distinct headings. 
The first is acute articular rheumatism and the second chronic 
rheumatism and gout. Unfortunately so many deaths are still re- 
ported as due to " rheumatism," without any qualification, that it is 
impracticable to determine which of these two conditions actually 
caused the deaths. The report of "rheumatism" is frequently 
made in cases where the deaths were due to the acute infection, 
rheumatic fever, a disease which has epidemic prevalence. This is 
the condition which the present title No. 47 of the International 
List (acute articular rheumatism) was intended to cover. Unfor- 
tunately, however, the same term "rheumatism" is also returned 
for many cases of arthritis deformans, which is a disease of the 
joints of doubtful etiology, but which ordinarily pursues a chronic 
course. It is also used in cases in which physicians intended it 
as the equivalent of "chronic rheumatism," a term used loosely 
for all sorts of long standing painful conditions of the joints, 
nerves, bones and other parts of the body. Any attempt at this 
time to show separately the mortality actually due to acute rheu- 
matic fever on the one hand and to chronic rheumatoid arthritis 



RHEUMATISM. 



243 



and to gout, on the other must, therefore, necessarily fail under 
present conditions of reporting and tabulation. 

This conclusion is fully demonstrated by an analysis of the age 
distribution of the deaths charged to acute articular rheumatism 
in the Metropolitan experience during the period 1911 to 1916. 
There were 3,409 deaths assigned to acute articular rheumatism 
during this six-year period, of which 1,023, or 30 per cent., were 
those of persons over 45 years of age. When these figures are con- 
sidered in connection with the fact that young adults are the ones 
principally affected by rheumatic fever and that considerably less 
than 10 per cent, of the cases, based on authentic experience, might 
be expected to affect those over 45 years of age, it is readily seen 
that it is very improbable indeed that the majority of these deaths 
in the higher age periods are correctly classified. This condition 
is even more pronounced in the reports of the general population, 
for according to the annual mortality report of the Census Bureau 
for 1915, out of 3,274 deaths charged to acute articular rheuma- 
tism, 1,383 or 42.2 per cent, were those of persons over 45 years of 
age. This is contrary to clinical experience. 

TABLE 158. 

Mortality from Eheumatism (Acute and Chronic), Classified by 

Color, Sex and by Age Period. 

Death Bates^per 100,000 Persons Exposed. 1911 to 1916. 

Experience of Metropolitan Life Insurance Company. Industrial Department. 





Persona. 


White. 


Colored. 


Age Period. 


Males. 


Females. 


Males. 


Females. 


All ages — one and 
over 


7.4 


6.8 


7.2 


9.4 


11.3 






1 to 4 

5 to 9 

10 to 14 

15 to 19 

20 to 24 

25 to 34 

35 to 44 

45 to 54 

55 to 64 

65 to 74 

75 and over. . 


2.8 

7.9 

7.6 

5.5 

4.0 

4.4 

5.8 

9.4 

16.3 

35.5 

57.6 


3.3 

8.0 

6.8 

5.7 

3.6 

4.0 

5.8 

9.8 

13.7 

28.3 

41.1 


2.4 

8.2 

8.8 

5.1 

3.9 

3.9 

4.3 

7.2 

14.8 

35.5 

56.9 


3.8 

5.5 

5.1 

5.1 

6.2 

5.0 

10.2 

15.6 

26.4 

41.8 

178.4 


1.3 

5.8 

7.1 

7.0 

5.5 

7.4 

9.9 

16.2 

30.8 

71.6 

90.7 



In this discussion, for the reasons noted above, it has been decided 
to combine the two International List titles and to consider them 



244 



MORTALITY STATISTICS OF INSURED WAGE EARNERS. 



as one statistically with the full knowledge that different clinical 
entities are included. Only the future will determine what the 
true incidence of these separate diseases is. 

The number of deaths from these two diseases combined among 
Metropolitan Industrial policyholders during the period 1911 to 
1916 was 4,007 and the death rate was 7.4 per 100,000 exposed. 
Of these deaths 3,409 were classified under " acute articular rheu- 
matism " with a corresponding death rate of 6.3 ; 598 deaths, with 
a rate of 1.1, were charged to "chronic rheumatism and gout." 
Of the 598 deaths charged to the latter, 502 or 83.9 per cent, were 
those of persons over 45 years of age. 

" Eheumatism," analyzed in this way, shows a higher death rate 
for females than for males among both white and colored policy- 
holders; it shows quite a pronounced excess in the death rate of 
colored persons over whites. This same excess is also exhibited in 
the reports for the general population. The higher death rates for 
the females, however, are in evidence chiefly during the three high- 
est age periods, and it will be observed that during the chief wage- 
earning periods, among white policyholders at least, the death rates 
for the males are somewhat greater. The table on page 243 pre- 
sents the mortality during the period 1911 to 1916 among Metro- 
politan Industrial policyholders by color, sex, and age. 

TABLE 159. 

Mortality from Eheumatism (Acute and Chronic), Classified by 

Color and by Sex. 

Death Bates per 100,000 Persons Exposed. Single Years in 

Period 1911 to 1916. 



ExperieDce of Metropolitan Life Insurance Company. 


Industrial Department. 




Persons. 


White. 


Colored. 


Year. 


Males. 


Females. 


Males. 


Females. 


1911 to 1916 


7.4 


6.8 


7.2 


9.4 


11.3 


1916 

1915 

1914 

1913 

1912 

1911 


5.9 
6.9 
7.3 

7.8 
8.2 
8.9 


6.2 
6.5 
6.4 
7.2 
7.3 
7.7 


5.6 

6.8 
7.2 
7.4 

7.8 
8.9 


6.4 
7.5 
9.4 
9.7 
14.1 
9.6 


7.8 
10.1 
11.2 
12.4 
11.6 
15.3 



The general trend of the mortality charged to these diseases is 
downward, the maximum for the period 1911 to 1916 among the 



ACUTE BEONCHITIS. 245 

insured having been the rate of 8.9 per 100,000 exposed in 1911 
and the minimum, that of 5.9 in 1916. A continuous decrease is 
shown throughout the intervening years. This downward tendency 
is observed for both white and colored policyholders. Table 159 
shows the trend of the mortality from "acute articular rheuma- 
tism" and "chronic rheumatism and gout" combined during the 
period 1911 to 1916. 

Acute Bkonchitis. 

There were 2,636 deaths among Metropolitan Industrial policy- 
holders from acute bronchitis during the six-year period 1911 to 
1916. This corresponds to a death rate of 4.9 per 100,000 living. 

The deaths are concentrated at the two extremes of life, that is, 
under age 5 and over age 65. Taking the experience as a whole, 70 
per cent, of all the deaths from acute bronchitis are found in these 
age periods. During the remaining years of life the deaths are so 
few as hardly to justify any particular comment. 

The death rate from acute bronchitis is considerably higher 
among colored than among white persons; the rate for females in 
each group is higher than for males. The highest rate in the total 
experience is found in the age group 75 years and over, 100.4 per 
100,000. The next highest rate is in the period 65 to 74 years, 
31.9 per 100,000. The age period 1 to 4 years follows with a rate 
of 27.0. These age characteristics, however, are very different 
when we consider the white and colored races. Among colored 
males and females, about one-half the deaths from acute bronchitis 
are found in the period 1 to 4 years ; this results in very high death 
rates for this early period of life ; in fact, the rate for colored males 
was over two and one-half times that for white males and that for 
colored females three and one- third times the rate for white females. 

The table on page 246 presents the facts by age period and for 
each sex and color group. 

It is impossible to make a fair comparison between the death rates 
referred to above and those for the expanding Kegistration Area 
of the United States. The reason is that acute bronchitis is a dis- 
ease which causes death chiefly in infancy and old age but more 
especially in early infancy. In the Eegistration Area over one- 
half of the deaths charged to this disease are of infants under one 
year of age and a very considerable number relate to persons over 



246 



MORTALITY STATISTICS OF INSUEED WAGE EARNERS. 



TABLE 160. 
Mortality feom Acute Bronchitis, Classified bt Color, Sex and by 

Age Period. 

Death Bates per 100,000 Persons Exposed. 1911 to 1916. 

Experience of Metropolitan Life Insurance Company. Industrial Department. 





Persons. 


White. 


Colored. 


Age Period. 


Males. 


Females. 


Males. 


Females. 


All ages — one and 
over 


4.9 


4.4 


4.8 


6.4 


7.5 






1 to4 

5 to 9 

10 to 14 

15 to 19 

20 to 24 

25 to 34 

35 to 44 

45 to 54 

55 to 64 

65 to 74 

75 and over . . 


27.0 

2.0 

.5 

.6 

.6 

1.0 

1.5 

2.3 

8.1 

31.9 

100.4 


23.5 

1.9 

.5 

.3 

.4 

.7 

1.3 

3.0 

8.0 

26.8 

68.1 


23.9 

1.7 

.2 

.4 

.4 

.4 

.9 

1.7 

8.7 

37.4 

123.1 


62.8 
1.9 
2.2 
1.0 
2.6 
3.4 
3.8 
4.2 
6.6 
8.4 

68.6 


80.0 
5.1 
2.5 
4.1 
2.1 
2.8 
3.4 
2.6 
5.7 
29.4 
81.7 



70 years of age. In the first of these age groups there are no Metro- 
politan policyholders at all, and for persons over 70 a far smaller 
proportion of Industrial policyholders were observed than were esti- 
mated to be in the general population. It is, therefore, not at all 
surprising that the crude rate for acute bronchitis in the general 
population is very much higher than that for the Industrial expe- 
rience but no significance can possibly be attached to these dif- 
ferences. 

There have been slight and unimportant changes in the death 
rate in the Industrial experience in the period between 1911 and 
1916^^.-- 
y-^-"""^^ Alcoholism, Acute or Chronic. 

There were 2,555 deaths among Metropolitan Industrial policy- 
holders during the period 1911 to 1916, which, on the basis of 
descriptions of causes of death on death claims, were classified as 
due to alcoholism. The death rate was 4.7 per 100,000 exposed. 
There were no marked variations in the mortality, as compiled, 
during the six-year period, the maximum rate for the period being 
that for 1912 (5.3) and the minimum for the year 1911 (4.0). 
Compared year by year with the death rates for the expanding Eeg- 
istration Area, it will be noted that those for the latter were, in 



ALCOHOLISM^ ACUTE OK CHKONIC. 



247 



general, a little higher than those for the policyholders, the single 
exception being the year 1912 when the rate was the same for each 
experience (5.3). 

Color, Sex, and Age Incidence. 

The death rate per 100,000 for white males (8.8) was higher 
than for colored males (6.8) and that for white females (1.6) was 
slightly in excess of the rate for colored females (1.5). The 
heaviest mortality was registered in the age period 35 to 44 years 
(14.2 per 100,000 exposed), with a rate in the following age 
period, 45 to 54 years, but slightly less (13.9 per 100,000). In 
these two age groups occurred 1,529 deaths or 59.8 per cent, of 
all the deaths reported from this cause among the insured group. 
Considerably more than half of the mortality from this cause 
occurs, year after year, in the experience of the expanding Eegis- 
tration Area between the ages of 35 and 55 years. The mortality 
under 25 years of age from alcoholism is negligible. For white 
males the rate for the period 45 to 54 years is slightly higher than 
in the preceding period ; for white females and for colored persons 
of each sex the rate at this period is either slightly lower than or 
identical with that for the preceding period. After age 54, how- 
ever, there is a uniform decline. The following table gives the 
rates per 100,000 exposed by color, sex, and by age period: 



TABLE 161. 
Mortality from Alcoholism, Classified by Color, Sex and by Age Period. 

Death Bates per 100,000 Persons Exposed. 1911 to 1916. 
Experience of Metropolitan Life Insurance Company. Industrial Department. 





Persons. 


White. 


Colored. 


Age Period. 


Males. 


Females. 


Males. 1 Females. 


All ages — one and 
over 


4.7 


8.8 


1.6 


6.8 


1.5 


ltol9 

20 to 24 

25 to 34 

35 to 44 

45 to 54 

55 to 64 

65 to 74 

75 and over. . 


.1 

1.0 

6.2 

14.2 

13.9 

10.2 

8.4 

4.8 


t 

1.7 
12.8 
32.2 
32.4 
24.0 
18.4 
12.8 


t 
.3 
2.4 
4.7 
4.1 
2.2 
2.3 


.3 
1.6 
6.0 
16.6 
14.7 
13.8 
16.7 
13.7 


.4 
1.1 
1.5 
3.1 
3.1 
1.3 



f Less than .05 per 100,000 exposed. 



248 MORTALITY STATISTICS OF INSURED WAGE EARNERS. 

Unreliability of the Data for Alcoholism. 

Published reports of deaths and death rates for alcoholism are 
not regarded seriously by those who compile them. The difficulties 
which beset the path of the vital statistician in obtaining figures 
covering mortality from this condition are many and serious. The 
same trouble is encountered as is found in dealing with the venereal 
diseases: physicians often hesitate and, in fact, wilfully refuse to 
write on death certificates the name of the primary cause of death 
when such cause is one which might cast a certain degree of odium 
on the family of the deceased. In such diseases as this many phy- 
sicians reason that if they cannot comply with the requirement of 
the law and at the same time have what they consider due regard 
for the confidence of patients and the positions of their families, 
they will disregard the spirit of the law and report as causes of 
death terminal or complicating conditions rather than primary 
causes. There is little question that each year thousands of deaths 
occur in which alcoholism was a factor but which are never re- 
turned as due to this cause. Many of the deaths reported as due 
to "cirrhosis of the liver" are deaths of which alcoholism was the 
primary and causative factor. Many that are ascribed to "menin- 
gitis " are caused by that variety known as alcoholic serous menin- 
gitis. Many reported as caused by "apoplexy" or "cerebral 
edema" are in reality cases of alcoholic cerebral apoplexy' or alco- 
holic cerebral edema, or what is commonly known as alcoholic " wet 
brain." 

The death rates in the table on page 247 are not presented, 
therefore, as figures representing the actual or approximate mor- 
tality from alcoholism among the Company's Industrial policy- 
holders. They represent reported conditions — not actual condi- 
tions. The rates would be much lower than they are if it were not 
for the fact that special inquiries by the Statistical Bureau have 
brought out the fact of the existence of alcoholism in many cases 
where no mention of it was made by the physicians in their state- 
ments to the Company or on certified copies of the death certifi- 
cates. Many years will elapse before even approximate death rates 
covering the mortality from this disease can be presented by any 
statistical office. 



CHAPTEE XVI. 

This chapter will deal with the following diseases : 

(1) Pellagra. 

(2) Malaria. 

(3) Angina Pectoris. 

(4) Ulcer of Stomach. 

(5) Acute Poliomyelitis. 

Pellagra. 

The facts for pellagra mortality in this investigation of insured 
wage earners are of special importance, first, because the areas rep- 
resented in this inquiry cover a large part of the region of pellagra 
incidence in the United States, and second, because the figures refer 
to the wage earning group of the population among whom pellagra 
is more prevalent than in populations generally. Furthermore, 
adequate data on the race or color, sex and age incidence, in rela- 
tion to persons exposed, are also available from this study and these 
may aid the laboratory and clinical experts in their researches into 
this disease. The published population mortality statistics do not, 
at present, offer such opportunities for the detailed examination 
of pellagra mortality. The table on page 250 gives an idea of the 
geographic distribution of pellagra in the several districts of the 
South and Southwest where most of the pellagra deaths in this 
experience were recorded. The color incidence is also shown. 

It will be observed upon comparison of the following table with 
the one for malaria (shown on page 256) that, in general, where 
malaria death rates are high, pellagra death rates are low. This 
does not, of course, indicate any relation between the two diseases. 
It does emphasize the fact, however, that the chief sanitary problem 
of the coast, gulf and river plain of the South is malaria and that 
of the Southern Appalachian Plateau, supporting a considerable 
factory population, is pellagra. Malaria and pellagra are two of 
the outstanding diseases and conditions which still constitute a 
serious menace to the efficiency of the Southern wage earner — more 
so for the negro than for the white man. Both diseases, when of 

249 



250 



MORTALITY STATISTICS OF INSURED WAGE EARNERS. 



TABLE 162. 

MOETALITY FEOM PELLAGRA IN SELECTED SOUTHERN DISTRICTS. 

Classified hy Color. Years 1914, 1915 and 1916 Combined. 
Bates per 100,000 Exposed. 

Experience of Metropolitan Life Insurance Company. Industrial Department. 



Area and District. 



Rate per 100.000. 


White. 


Colored. 


3.3 


17.9 


27.5 


57.6 


16.0 


28.7 


16.5 


63.1 


68.8 


106.0 


67.7 


101.0 


176.6 


293.9 


102.3 


108.5 


33.4 


70.4 


5.4 


19.1 


11.4 


8.7 


81.4 


102.4 


53.1 


98.1 


35.1 


127.3 


167.5 


167.9 


83.8 


117.8 


51.5 


57.5 


29.5 


61.2 


68.8 


56.8 


22.3 


109.3 


41.4 


40.3 


24.2 


19.6 


56.2 


52.3 



Entire Metropolitan Experience 
Southern districts combined . . 

Birmingham, Ala 

Little Rock, Ark 

Atlanta, Ga 

Augusta, Ga 

Columbus, Ga 

Macon, Ga 

Savannah, Ga 

New Orleans, La 

Poplar Bluff, Mo 

Charlotte, N. C 

Greensboro, N. C 

Raleigh, N.C 

Columbia, S. C 

Spartanburg, S. C 

Chattanooga, Tenn 

Jackson, Tenn 

KjioxvUIe, Tenn 

Memphis, Tenn 

Nashville, Tenn 

Richmond, Va 

Roanoke, Va 



the chronic type, involve long periods of disability for work and in 
certain areas of intensive incidence, are the cause of heavy pre- 
ventable mortality at the productive ages of life. Among the white 
industrial population in certain sections of the South, malaria and 
pellagra, together, often assume more importance as causes of death 
than does tuberculosis. 

Before drawing any conclusions on the comparative color, sex 
and age incidence of the disease it should be remarked that the 
exposure upon which the death rates reported in this study are 
based, comprises all of the Company's policyholders in the United 
States and in Canada. A very large proportion of this exposure, 
therefore, was located in nonpellagrous territory. In the discus- 
sion of malaria it will he remarked that 20 per cent, of the Com- 
pany's total exposure to risk was located in the Southern and 



PELLAGRA.. 



251 



Southwestern sections of the country. In order to have death rates 
best constituted for purposes of investigating the true color, sex 
and age incidence of the disease it would be desirable to confine 
the exposure and deaths to pellagrous portions of the country. 
This is, however, quite impracticable at the present time both for 
population and insurance data. The rates are presented with this 
reservation as to the lack of homogeneity in the geographic areas 
of the exposures and of the deaths. The figures have considerable 
value, nevertheless, as will be seen in the following table: 



TABLE 163. 

Mortality pkom Pellagra, Classified by Color, Sex and by Age Period. 

Death Bates per 100,000 Persons Exposed. 1911 to 1916. 
Experience of Metropolitan Life Insurance Company. Industrial Department. 





Persons. 


White. 


Colored. 


Age Period. 


Males. 


Females. 


Males. 


Females. 


AH ages — one and 
over 


4.3 


1.6 


3.9 


6.4 


20.7 






lto4 

5 to 9 

10 to 14 

15 to 19 

20 to 24 

25 to 34 

35 to 44 

45 to 54 

55 to 64 

65 to 74 

75 and over. . 


.4 

.3 

.6 

.9 

2.8 

5.5 

8.9 

9.2 

13.0 

11.9 

10.1 


.2 

t 

.2 

.3 

.3 

1.4 

2.9 

4.1 

10.9 

10.3 

9.9 


:5 

.2 

.5 
.9 
2.5 
4.8 
8.4 
8.1 
10.1 
8.8 
5.0 


2.3 
2.3 

2.7 

1.3 

2.3 

4.6 

8.8 

15.3 

19.2 

21.7 

41.2 


1.5 

3.5 
3.4 
6.2 
19.8 
24.5 
31.1 
30.9 
39.2 
41.1 
45.4 



■{■Less than .05 per 100,000 exposed. 

There is a constantly rising death rate with advancing age. The 
disease has its lowest incidence as a cause of death in the ages of 
childhood. In fact, the number of deaths of white children under 
15 is negligible; colored children show a larger number of cases. 
After age 15, the rates increase regularly with age until the age 
period 55 to 64 years is reached. From this point onward the rates 
fall slightly among white lives but continue to increase among the 
colored 

The death rate among colored persons is higher than among 
white persons. This is true at every age period and for both sexes. 
In fact, the rate is four times as high for the colored males as for 
the white males, all ages combined, and more than five times as 



252 MORTALITY STATISTICS OF INSURED WAGE EARNERS. 

high for the colored females as for the white females. This con- 
dition is largely the result of the different geographic distributions 
of the white and colored policyholders. The latter reside for the 
most part in the Southern States where pellagra is common, whereas 
the majority of white policyholders reside in the Northern States 
where pellagra is still very rare. There is, nevertheless, a real 
excess in the mortality rate among the colored as is shown by the 
figures in the first table of this section for a number of representa- 
tive southern cities and towns where pellagra has been prevalent for 
a number of years. 

The rate for females is higher than for males both among the 
white and among the colored. This is found at virtually every age 
period. From ages 25 to 54 years the pellagra death rate of white 
males is only from 30 to 50 per cent, that of white females. Begin- 
ning with the age period 55 to 64 years and continuing to the end 
of the table, white males, however, show a higher pellagra mortality 
than do white females. Colored males at all age periods show 
lower death rates for pellagra than do colored females. It would 
be very interesting to learn why females in this country have the 
higher rates since no such relation between pellagra death rates of 
the sexes has been observed in a number of other countries where 
the disease is prevalent. 

Comparison of Pellagra Mortality Among Insured Wliite Persons 

and Among the General Population of the Expanding 

Registration Area of the United States. 

A comparison of pellagra mortality among this group of insured 
wage earners and among the population of the expanding Regis- 
tration x\rea in the United States is possible under certain limiting 
conditions. It must be remembered, in the first place, that the 
exposure to risk in the insurance experience covers a very much 
larger proportion of persons in the pellagrous region of the South 
and Southwest than does the population included in the expanding 
Registration Area of the United States. This fact in itself would 
account for the great excess in pellagra death rates of insured white 
persons. Thus, between 25 and 64 years for both white males and 
white females, there is, practically, a constantly rising rate of excess 
in the pellagra death rate of insured white persons over the rates for 
the general population of the Registration Area. The excess is 



PELLAGRA. 



253 



more marked for insured white males than for insured white females. 
In view of the difference between the two sets of data as to geo- 
graphic area and as to the social status of persons included in both 
experiences, it would be well not to stress comparison of the figures 
too far. The pellagra mortality experience of the Eegistration 
Area, 1910 to 1915, and of insured white persons, 1911 to 1916, 
according to sex and age period is shown comparatively in the fol- 
lowing table: 

TABLE 164. 

Mortality from Pellagra. 

Death Rates per 100,000 Persons Exposed. Classified by Sex and Age Periods. 
Insured White Lives in Experience of Metropolitan Life Insurance Com- 
pany, Industrial Department (1911 to 1916) and General Popula- 
tion of Expanding Registration Area of the United States 
(1910 to 1915). 





Males. 


Females. 


Age Period. 


M. L. I. Co. 

(Whit*). 


U. S. Keg. 
Area. 


Percentage 
M. L. I. Co. 
of Reg. Area. 


M. L. 1. Co. 

(White). 


U. S. Reg. 
Area. 


Percentage 
M. L. I. Co. 
of Reg. Area. 


All ages — one 
and over. . . 


1.6 


1.1 


145.5 


3.9 


2.8 


139.3 


1 to 4 


.2 


.2 


100.0 


.5 


.3 


166.7 


5 to 9 


t 


.3 


10.0 


.2 


.3 


66.7 


10 to 14... 


.2 


.2 


100.0 


.5 


.4 


125.0 


15 to 19.... 


.3 


.2 


150.0 


.9 


1.0 


90.0 


20 to 24.... 


.3 


.5 


60.0 


2.5 


2.4 


104.2 


25 to 34... 


1.4 


.9 


155.6 


4.8 


3.7 


129.7 


35 to 44.... 


2.9 


1.4 


207.1 


8.4 


5.2 


161.5 


45 to 54.... 


4.1 


2.3 


178.3 


8.1 


4.9 


165.3 


55 to 64.... 


10.9 


3.8 


286.8 


10.1 


5.4 


187.0 


65 to 74.... 


10.3 


3.8 


271.1 


8.8 


4.9 


179.6 


75 and over 


9.9 


3.4 


291.2 


5.0 


3.7 


135.1 



f Less than .05 per 100,000 exposed. 



An examination of the above table will show some interesting 
similarities in the two experiences. In the first place, females in 
both cases show higher rates than do males; there are only a few 
unimportant exceptions. Secondly, the rates increase with ad- 
vancing age. In spite of their differences, therefore, the two sets 
of data confirm one another in essential respects. If they do not 
correspond more closely in actual rates it is because they refer to 
different geographic areas. The above conclusion is confirmed by 
the similar distribution of the deaths from pellagra by age in the 
two experiences as is shown in the following table : 



254 



MORTALITY STATISTICS OF INSURED WAGE EARNERS. 



TABLE 165. 

Number and Percentage Distribution of Deaths from Pellagra. 
1911 TO 1915. Classified by Age Period. 

Insured White Lives in Experience of Metropolitan Life Insurance Company, 

Industrial Department, and General Population of Expanding 

Eegistration Area of the United States. 





Metropolitan Experience. 


V. S. Registration Area. 


Age Period. 




Per Cent, of 




Per Cent, of 




No. of Deaths. 


Total. 


No. of Deaths. 


Total. 


All ages — one and over 


1942 


100.0 


6694* 


100.0 


ltol4 


74 


3.8 


264 


3.9 


15 to 19 


52 


2.7 


193 


2.9 


20 to 24 


136 


7.0 


491 


7.3 


25 to 34 


394 


20.3 


1326 


19.8 


35 to 44 


453 


23.3 


1565 


23.4 


45 to 54 


355 


18.3 


1214 


18.1 


55 to 64 


340 


17.5 


947 


14.1 


65 to 74 


120 


6.2 


516 


7.7 


75 and over 


18 


.9 


178 


2.7 



* Known ages only. 

The two distributions are much alike. It is only after age 55 
that differences make themselves felt and these are the result in all 
probability of the very different age constitution of the living in 
the two groups; the proportion of policyholders after age 65 is 
very much lower than the proportion in the corresponding age 
group of the general population. For the ages preceding this 
period of life, however, there is virtual correspondence. 



Trend of the Death Rate from Pellagra. 

The death rate from this disease may be expected to vary accord- 
ing to the greater or less intensity of the factors which produce the 
disease in the first place, and which aggravate the disease and re- 
tard recovery in the second place. It has been fairly well estab- 
lished by recent research work of the U. S. Public Health Service 
that pellagra is a deficiency disease, the result of a persistent ab- 
sence in the diet of meat, eggs, milk, beans, peas and other proteins. 
The every-day diet of the wage earning element in the South is 
characterized by this deficiency and is conditioned primarily by the 
state of industry, the regularity of emplojrment and the wage-level. 
An important secondary fact not to be overlooked, however, is the 
general status of some parts of the industrial population of the 
South as regards efficiency in personal and home life, and whether 



PELLAGKA. 



255 



or not there is disregard of the plain facts of hygiene, diet and 
order in the home. 

In the following table are shown the facts of pellagra mortality 
for the six year period 1911 to 1916, distinguishing single calendar 

years : 

TABLE 166. 

Mortality feom Pellagra, Classified by Color and by Sex. 

Death Bates per 100,000 Persons Exposed. Single Years in 
Period 1911 to 1916. 

Experience of Metropolitan Life Insurance Company. Industrial Department. 





Persona. 


White. 


Colored. 


Year. 


Males. 


Females. 


Males. 


Females. 


1911 to 1916 


4.3 


1.6 


3.9 


6.4 


20.7 


1916 

1915 

1914 

1913 

1912 

1911 


3.6 
6.7 
5.3 
3.3 
2.8 
3.6 


1.4 
2.1 
2.2 
1.3 
1.2 
1.7 


2.7 
5.9 
4.7 
3.4 
2.6 
4.1 


6.2 
12.2 
6.9 
4.6 
4.1 
3.4 


22.4 
36.6 
26.7 
13.1 
12.5 
10.5 



The possible effect of economic conditions upon the incidence of 
pellagra may be seen from the foregoing data. Late in 1914 and 
in 1915, when the economic situation in the South was exceedingly 
grave, the pellagra mortality rates were high. In 1916, following 
a period of economic revival, characterized by an extraordinary 
movement of raw and manufactured cotton products, resulting in 
prosperity for both employers and wage earners alike, the pellagra 
death rate dropped to a figure of 3.6 per 100,000 exposed. These 
economic facts affected both the white and colored groups in this 
experience, and likewise, probably, the pellagra death rates of these 
groups. 

It must be remembered that pellagra manifests itself mainly in 
two clinical forms, an acute type and a chronic recurrent form. It 
is probable that an improvement in the industrial situation which 
results in better wages and regular employment and consequently 
in a more generous family diet reduces the number of acute cases 
and that it modifies the severity of the chronic recurrent form of 
the disease. 



256 



MORTALITY STATISTICS OF INSUEED WAGE EARNERS. 



Malaria. 

No infection, except perhaps tuberculosis, compares with malaria 
in the extent of its geographic distribution or in its importance as 
a cause of physical disability among mankind generally. Fifty 
years ago, in the United States, malaria seriously affected nearly 
every state then fairly thickly populated. Noteworthy epidemics 
were recorded in Michigan, New Jersey, Pennsylvania and Massa- 
chusetts, as well as in the South, where the disease still lingers as 
a cause of considerable and preventable loss. The advance of sani- 
tary engineering, the growth of populations and the subsequent 
filling-in of swampy areas have gradually eliminated the breeding 
grounds of the anopheles mosquito and have thus almost eradicated 
malaria from the northern tier of states. The very largest regis- 
tration of malaria in this mortality experience of wage earners was 
drawn from the group of persons insured in the southern and 
southwestern portions of the United States. It is significant to 



TABLE 167. 

Mortality from Malaria in Selected Southern Districts. 

Classified by Color. Years 1914, 1915 and 1916 Combined. 

Bates per 100,000 Exposed. 

ExperieDce of Metropolitan Life Insurance Company. Industrial Department. 



Area and Diatxict. 



Rate per 100,000. 



Entire Metropolitan Experience 

Southern districts combined . . 

Birmingham, Ala 

Little Rock, Ark 

Augusta, Ga 

Columbus, Ga 

Macon, Ga 

Savannah, Ga 

Cairo, 111 

Paducah, Ky 

New Orleans, La 

Poplar Bluff, Mo 

St. Louis, Mo 

Charlotte, N. C 

Raleigh, N. C 

Columbia, S. C 

Jackson, Tenn 

Memphis, Tenn 

NashviUe, Tenn 



L4 



9.3 



5 
33 
32 
12, 
28, 
11, 
44, 
54, 

4, 
106, 

2, 

4. 
15, 
17, 
51, 
33, 

2, 



15.8 



41.6 



35.9 

160.7 

34.5 

S4.5 

36.2 

130.3 

54.2 

73.2 

36.4 

60.9 

9.4 

46.5 

50.9 

21.7 

89.0 

105.9 

17.6 



MALAEIA. 



267 



observe also that most of these malaria deaths occurred in the 
coastal, gulf and river plain of the South and nominally few of them 
on the Appalachian Plateau. The table on page 256 shows the geo- 
graphic distribution of the malaria deaths in this mortality expe- 
rience for the combined years 1914, 1915 and 1916, the only three 
years for which the data are fully available with respect to geo- 
graphic incidence. 

The 2,295 deaths from malaria in the experience of the six year 
period correspond to a death rate of 4.3 per 100,000 persons exposed. 
It should be remembered in considering this rate that whereas most 
of these deaths from malaria came from territory in the southern 
and southwestern sections of the United States, the exposure upon 
which the death rates are based covers all of the Company's policy- 
holders in the United States and Canada. The southern and south- 
western business of the Company in 1916 constituted approxi- 
mately 20 per cent, of the total exposure. The total rate is there- 
fore devoid of much meaning although the figures for the incidence 
by color, sex and age do show interesting interrelations and these 
are given in the following table : 

TABLE 168. 
MOETAIilTY FROM MALARIA, CLASSIFIED BY COLOR, SEX AND BY AGE PERIOD. 

Death Bates per 100,000 Persons Exposed. 1911 to 1916. 
Experience of Metropolitan Life Insurance Company. Industrial Department. 





Persons. 


White. 


Colored. 


Age Period. 














Males. 


Females. 


Males. 


Females. 


All ages — one and 












over 


4.3 


2.1 


1.9 


17.8 


22.1 






1 to 4 


6.5 


3.7 


3.7 


42.9 


44.4 


5 to 9 


3.2 


2.2 


1.7 


16.6 


17.3 


10 to 14 


1.9 


1.1 


1.1 


5.4 


13.4 


15 to 19 


1.9 


.9 


.7 


9.9 


12.9 


20 to 24 


2.8 


1.2 


1.2 


13.8 


14.5 


25 to 34 


3.4 


1.4 


1.1 


12.4 


14.7 


35 to 44 


3.8 


2.0 


1.3 


11.2 


16.1 


45 to 54 


6.5 


3.3 


2.6 


24.4 


29.0 


55 to 64 


10.0 


3.9 


4.5 


41.4 


54.6 


65 to 74 


16.0 


8.4 


7.0 


81.9 


89.3 


75 and over. . 


15.4 


9.9 


4.2 


123.5 


99.8 



Comparisons between the white and colored malaria death rates 
should be made with special caution. Most of the colored policy- 

18 



258 



MORTALITY STATISTICS OF INSURED WAGE EARNERS. 



holders in the Company's experience are located in the South and 
Southwest, and this fact alone would conduce to a much higher 
malaria death rate than was recorded among white persons, the 
majority of whom are located in northern areas not affected to any 
great extent by malarial infection. The comparative malaria death 
rates presented in the introductory table to this section will give 
some idea, however, of the relative color incidence at least of deaths 
from malaria. 

According to the age statistics, malaria mortality was nearly 
eight and one-half times as frequent among colored males and 
nearly 12 times as frequent among colored females as among the 
corresponding sex groups of the white population. Males of the 
white experience showed a malaria death rate practically eleven per 
cent, higher than did females of the same race group. Colored 
males, on the other hand, showed a malaria mortality practically 
twenty per cent, more favorable than the rates for colored females. 
It is not possible to account for this reversal of the sex ratio of 
malaria mortality from the facts at hand. 

The age characteristics of the malaria mortality curve are well 
defined. The highest rates are found at the two extremes of life, 
the minimum being reached at the period of adolescence. From 
age 20 onward the rates increased fairly regularly with only here 
and there an exception. A high mortality figure for the period of 
early childhood is to be noted. 



TABLE 169. 

MOETALITY FROM MALARIA, CLASSIFIED BY SEX AND BY AgE PERIOD. 

Death Bates per 100,000 Persons Exposed. 1910 to 1915. 
Experience of the Expanding Eegistration Area of the United States. 



Age Period. 



All ages — one and over . 



2.4 



1 to4 

5 to 9 

10 to 14.... 
15 to 19.... 

20 to 24 

25 to 34 

35 to 44.... 
45 to 64 ... . 
55 to 64 ... . 
65 to 74.... 
75 and over. 



2.4 



4.4 


4.9 


1.7 


1.6 


1.0 


1.2 


1.2 


1.3 


1.5 


1.7 


1.5 


1.6 


1.8 


1.7 


2.7 


2.3 


4.5 


3.6 


5.9 


6.0 


13.1 


11.6 



MALARIA. 



259 



Because of the sharp differences in geographic distribution of 
the two groups of exposed lives it is not deemed desirable to make 
a direct comparison between the death rates of insured wage earners 
and those for the general population in the expanding Registration 
Area of the United States. It may be of interest, however, to 
observe the very similar conformation of the curve of mortality by 
age and sex in the Eegistration Area during the period 1910 to 
1915. This is offered on page 258. 

At some of the age periods the death rates of the insured expe- 
rience are higher and at others they are lower than those shown for 
the Registration Area considered by sex, but no significance may 
be attached to these ratios. The population mortality figures for 
the disease, however, are valuable in that they confirm the relation 
previously outlined in the death rates by age period, namely, a crest 
at each end of the mortality curve and a minimum point between 
10 and 20 years of age. 

Trend of the Malaria Death Rate — 1911 to 1916. 

The malaria death rate of 1911 was the highest and the rate of 
1916 was the lowest in the Industrial experience. During this 
period the rate declined without exception, the figure for 1916 
being less than one-half that recorded for 1911. The decline was 
more pronounced for white than for colored persons and greater 
for females than for males in each color group. The facts are 
shown below for each of the single calendar years : 



TABLE 170. 

MOETAUTY FROM MALARIA, CLASSIFIED BY COLOR AND BT SEX. 

Death Bates per 100,000 Persons Exposed. Single Years in 
Period 1911 to 1916. 

Experience of Metropolitan Life Insurance Company. Industrial Department. 





Persons. 


White. 


Colored. 


Year. 


Males. 


Females. 


Males. 


Females. 


1911 to 1916 


4.3 


2.1 


1.9 


17.8 


22.1 


1916 

1915 

1914 

1913 

1912 

1911 


2.9 
3.5 
3.7 
4.5 
5.4 
6.1 


1.4 
1.7 
1.7 
2.1 
3.1 
3.2 


1.3 

1.8 
1.6 
1.8 
2.4 
3.0 


14.4 
14.3 
16.2 
20.5 
20.9 
21.2 


15.1 
17.7 
21.0 
23.5 
26.6 
30.6 



260 mortality statistics of insured wage earners. 

Angina Pectoris. 

Two thousand two hundred and eighteen (2,218) deaths from 
angina pectoris were reported in this experience during the six 
year period 1911 to 1916, corresponding to a death rate of 4.1 per 
100,000 exposed. In no year was the mortality from this cause 
noticeably high as compared with other years. The maximum 
death rate was observed in 1913 (4.4) and the minimum in 1916 
(3.8). 

The death rates for the expanding Eegistration Area of the 
United States showed the same general uniformity but were con- 
siderably higher than those for the Metropolitan experience. The 
maximum rate for the Eegistration Area during the sexennium was 
7.7 per 100,000 population in 1915 and the lowest was that for 
1911 (7.1). The higher mortality in the Eegistration Area as 
compared with the Metropolitan experience was due almost alto- 
gether to the age distribution of the two experiences. About 40 
per cent, of the deaths due to angina pectoris are those of persons 
over 70 years of age and the exposure at these ages is very much 
smaller among the Industrial policyholders than in the population 
of the Eegistration Area. 

Color, Sex and Age Incidence. 

The death rates for Metropolitan policyholders were identical for 
white and colored males (4.6), but showed a rather marked excess 
for colored females (5.8) over white females (3.5). Among white 
policyholders, the death rate for males was higher than that for 
females, but among colored policyholders the contrary was true. 
Among white decedents, the excess of mortality of males over fe- 
males was very marked for the age groups in which the greatest 
number of deaths occurred, namely, 45 to 54, 55 to 64 and 65 to 
74 years. Among colored persons the rates for females for the age 
periods 45 to 54 years (15.7) and 65 to 74 years (38.8) were much 
higher than those for males at these age periods (10.1 and 30.1) ; 
for the period 55 to 64 years, however, the male rate (21.0) slightly 
exceeded the female rate (19.8). 

The following table presents the facts by color, sex and age : 



ANGINA PECTOEIS. 



261 



TABLE 171. 

Mortality from Angina Pectokis, Classified by Color, Sex and by 

Age Period. 

Death Rates per 100,000 Persons Exposed. 1911 to 1916. 

E-Tperience of Metropolitan Life Insurance Company. Industrial Department. 





Persons. 


White. 


Colored. 


Age Period. 


Males. 


Females. 


Males. 


Females. ■ 


All ages — one and 
over 


4.1 


4.6 


3.5 


4.6 


5.8 






1 to 24 

25 to 34 

35 to 44 

45 to 54 

55 to 64 

65 to 74 

75 and over. . 


.2 

1.2 

3.4 

8.3 

21.4 

49.4 

70.1 


.1 
1.2 
3.5 
12.0 
28.9 
68.8 
73.8 


.2 

.9 

2.2 

4.6 

16.8 

39.8 

73.7 


.5 

2.0 

7.6 

10.1 

21.0 

30.1 


.3 

2.8 
6.4 
15.7 
19.8 
38.8 
54.4 



In the analysis of these figures, it should be borne in mind that 
the number of deaths involved among colored policyholders was 
only 353 and that this number is quite too small to use as a basis 
for important conclusions. Another point should be remembered, 
namely, that the term " angina pectoris " is used loosely in this 
country. It is still a favorite expression, especially with coroners, 
in cases of sudden death. 



Ulcer of the Stomach. 

Ulcer of the stomach caused 2,159 deaths among Metropolitan 
Industrial policyholders during the six year period 1911 to 1916, 
corresponding to a death rate of 4.0 per 100,000 exposed. Ex- 
amination of the rates for the different years shows that there were 
no fluctuations of importance, the rate for 1915 (3.8) showing the 
greatest deviation from the average for the period. The death rate 
for ulcer of the stomach in the Eegistration Area showed a slight 
upward trend; in fact this has been continuous during the period, 
the maximum (4.6) being that for the year 1916. 

Color, Sex and Age Incidence. 

The crude death rates for the Metropolitan Industrial policy- 
holders indicate a higher incidence for colored persons than for 
white persons, and a preponderance of mortality of males among 



262 



MOETALITT STATISTICS OF INSURED WAGE EARNERS. 



the white, but of females among the colored. Among the males, the 
highest rates were found at the age period 75 and over, 21.3 per 
100,000 for the white and 41.2 per 100,000 for the colored. There 
was a continuous increase throughout the lower age periods until 
the maximum was reached at the age period 75 years and over. 
Females had the highest rates at the age period 65 to 74 (17.9 and 
28.2 per 100,000 white and colored policyholders respectively). 
Beginning with the earliest period, they also showed a continuous 
increase throughout the lower age groups. 

The following table shows the color, sex and age incidence of 
ulcer of the stomach among Metropolitan Industrial policyholders : 



TABLE 172. 

-Mortality from Ulcer of the Stomach, Classified by Color, Sex 
AND BY Age Period. 

Beath Bates per 100,000 Persons Exposed. 1911 to 1916. 

ExperieDjce of Metropolitan Life Insurance Company. Industrial Department. 





Persons. 


White. 


Colored. 


Age Period. 


Males. 


Females. 


Males. 


Females. 


All ages — one and over 


4.0 


4.3 


3.1 


6.2 


6.4 


ltol9 

20 to 24 

25 to 34 

35 to 44 

45 to 54 

55 to 64 

65 to 74 

75 and over 


.4 

2.0 

3.9 

7.6 

9.7 

12.9 

19.7 

18.7 


.3 

1.8 
4.6 
10.3 
15.3 
17.4 
19.1 
21.3 


.4 
1.8 
2.8 
5.0 
6.0 
9.3 
17.9 
15.9 


.4 
2.3 
5.5 
11.8 
11.1 
16.2 
35.1 
41.2 


1.1 

4.0 
6.3 
9.1 
10.7 
15.0 
28.2 
18.1 



Acute Poliomyelitis. 

With the exception of the single year 1916, acute poliomyelitis 
has caused only between 100 and 150 deaths per annum in the en- 
tire mortality experience of insured wage earners under review. 
The death rate varied from 1.2 to 1.8 per 100,000 persons exposed 
between 1911 and 1915. In 1916, however, an epidemic of the 
disease occurred and the rate rose to 12.2 per 100,000. The cases 
in that year were, for the most part, confined to the Middle Atlantic 
and to a few of the New England States. The City of New York 
showed by far the largest number of cases recorded. Out of the 
total of 1,245 cases registered in 1916, 456 or 36.6 per cent, were 



ACUTE POLIOMYELITIS. 



263 



reported from that city. There was also a noteworthy representa- 
tion of deaths from the cities of Newark and Philadelphia. 

Poliomyelitis has a very marked color, sex and age incidence. 
In this respect, it is very similar to the other acute infectious dis- 
eases of childhood already considered. This is made evident in the 
following table, which displays the color, sex and age incidence of 
this disease for 1916 alone: 



TABLE 173. 

Mortality from Acute Poliomyelitis, Classified by Color, Sex and by 

Age Period. 

Death Bates per 100,000 Persons Exposed. Year 1916. 

Experience of Metropolitan Life Insurance Company. Inidustrial Department. 





Persons. 


White. 


Colored. 


Age Period. 


Males. 


Females. 


Males. 


Females. 


All ages — one and 
over 


12.2 


16.9 


10.2 


6.2 


3 5 






lto4 

5 to 9 

10 to 14 

15 to 19 

20 to 24 

25 and over. . 


86.4 

26.9 

4.8 

2.4 

1.2 

.4 


99.7 

31.8 

5.7 

3.2 

1.0 

.9 


75.3 

23.5 

4.9 

1.6 

1.2 

.3 


79.4 
19.1 

1.9 
3.6 


53.0 
15.1 

1.7 



White males and white females suffer much more acutely from 
poliomyelitis than do the same sex groups among colored people. 
It should be recalled, though, that in this mortality experience 
colored and white persons were very unequally exposed to the dis- 
ease. Males show higher mortality rates than do females at every 
age period with the exception of the age period 20 to 24 years. The 
disease takes its highest toll in the earliest years of childhood. In 
fact, the rate for white males under five, 99.7 per 100,000, was 
higher than the death rate for measles (84.1 per 100,000) and for 
scarlet fever (53.5 per 100,000) in the corresponding age period of 
life. The same fact was observed for the age period five to nine. 
The rates decrease rapidly beginning with age ten years, and the 
deaths are very few after age 25. Only 100 deaths after age 25 
occurred out of the total of 1,889 deaths in the six year period. 



CHAPTEE XVII. 

Miscellaneous Diseases and Conditions. 

In addition to the major diseases and conditions discussed in the 
foregoing text there are a number which have played a not incon- 
siderable part in this mortality experience. Some of these justify 
brief discussion because of their importance as public health prob- 
lems, irrespective of the relatively small number of deaths due to 
them; others claim attention because they illustrate recent tenden^ 
cies in the technique of mortality statistics. The figures represent- 
ing the number of deaths from these minor conditions should be 
accepted in most cases with some reservation. In practically all 
instances there has been an apparent decline in the death rate for 
these causes of death during the six year period. This, we believe, 
is due, in large part, to improved certification of the causes of death 
by physicians. The increasing interest of physicians in preventive 
medicine, the circulation, by various vital statistics offices, of educa- 
tional literature on the certification of causes of death, and the many 
letters written to physicians asking them for more definite state- 
ments of causes of death, have resulted in reducing by many thou- 
sands the registration of deaths under these titles and correspond- 
ingly increasing the numbers assigned to the more approved and 
reliable headings of the International List. These diseases and 
conditions of miscellaneous order will be considered according to 
their International List position. 

Dysentery. 

Under dysentery were classified 2,039 deaths during the expe- 
rience period, corresponding to a death rate of 3.8 per 100,000 
exposed. There has been a practically continuous decline in the 
death rate during the sexennium. The maximum rate is that for the 
year 1911 (4.8). The minimum rate was recorded in 1916 (3.1). 
The term "dysentery" is used by physicians very loosely in this 
country. True amebic dysentery, caused by the ameha dysen- 
teriae, is comparatively rare in North America with the exception 

264 



MISCELLANEOUS DISEASES AND CONDITIONS. 235 

of the southern states. The type known as bacillary dysentery, 
which occurs both sporadically and in epidemics, is also infrequent 
because of steadily improving sanitary conditions. It has been 
estimated, and, in fact, fairly well demonstrated by registration 
offices, that a large proportion of the "dysentery" (so reported) in 
the United States is really enteritis or gastroenteritis. This is 
true especially in cases where it is reported for infants under two 
years of age. Examination of the Census Bureau reports on mor- 
tality statistics shows that approximately one third of the mortality 
reported for dysentery is that of children under two years of age. 
Very little of this, as a matter of fact, is correctly assignable to 
this title. The deaths which have been "charged away" from 
dysentery in the insurance experience have gone to swell the totals, 
chiefly, of diarrhea and enteritis and abdominal tuberculosis. 

Erysipelas. 

Twelve hundred and eighty-nine erysipelas (1,289) deaths were 
registered during the six year period 1911 to 1916. The death 
rate was 2.4 per 100,000 exposed. There has been no marked 
change during the period in the death rate for this condition. The 
death rates for white policyholders are considerably in excess of 
those for the colored, and the mortality among males for each race 
exceeds that among females. In the general population experience 
the death rates are higher than those for the Company's Industrial 
policyholders. This is due chiefly to the fact that approximately 
one third of the mortality caused by erysipelas is among infants 
under one year of age, a class which does not form a part of the 
Metropolitan experience. 

Under erysipelas are classified all deaths so reported, with no 
information as to type or primary cause. These include cases of 
slight traumatism complicated by the disease, but do not include 
those deaths in which erysipelas supervenes nor violence cases where 
the traumatism, in itself, would have caused death. 

Purulent Infection and Septicemia. 

Under this heading were classified 1,083 deaths, corresponding 
to a death rate of 2.0 per 100,000 exposed. The general trend of 
mortality throughout the six year period has been downward. Sev- 
eral hundreds of deaths which would have been classified under this 



266 MORTALITY STATISTICS OF INSURED WAGE EARNERS. 

heading on the basis of the original reports received from physi- 
cians, have been transferred to other titles on the basis of more 
definite data supplied by these physicians. As an illustration of 
the loose manner in which the term "septicemia" is used by 
American physicians, we may cite the result shown by 295 replies 
from physicians^ who reported it as a cause of death of policy- 
holders in this investigation during the six years 1911 to 1916. In 
207, or 70.2 per cent, of these cases, the deaths, on the basis of the 
corrective data furnished by the physicians, were charged to titles 
other than purulent infection and septicemia. Of the 207 replies 
that were received 76 or 25.8 per cent, were assigned to puerperal 
septicemia alone. The remainder were scattered among various 
diseases and forms of violence. The published death rate in the 
expanding Eegistration Area of the United States has been showing 
a decreasing trend for many years which, also, is due to the fact 
that physicians are reporting under the primary diseases cases 
where blood poisoning was a complication of the primary causative 
condition. 

Gonococcus Infection. 

The number of deaths charged to this disease (200) during the 
six years covered by this report does not indicate that this is a 
factor of much importance in this mortality experience. The 
death rate for the period was but .4 per 100,000 exposed on the 
basis of the reports of gonococcus infection which have been re- 
turned. Low as this figure is, it is, nevertheless, a matter of in- 
terest that when the rate for the last year of the sexennium (.5) is 
compared with that for the first year (.2) it is seen that there has 
been an apparent increase of 150 per cent. As a matter of fact, 
however, this rise is only apparent and is due, in large part, to the 
constantly increasing care which physicians are exercising in re- 
porting primary causative factors on forms provided for statements 
of causes of death. The reports for the general population show 
an even greater apparent increase in the death rate for gonococcus 
infection. For the year 1916 the general population death rate 
was .8 per 100,000 population, which is double the rate for 1911 
(.4) and eight times the annual average rate for the period 1901 to 
1905 (.1). It is evident that published figures for this disease 

1 See Appendix C. 



MISCELLANEOUS DISEASES AND CONDITIONS. 267 

can not be taken as a reliable index of its incidence as a cause of 
death. 

Anemia, Chlorosis. 

One thousand seven hundred and seventy-two (1,772) deaths 
were charged to these diseases during the sexennium 1911 to 1916. 
The great majority were reported under one of the following ex- 
pressions: anemia (without qualification), Banti's disease, chloro- 
sis, pernicious anemia, and splenic anemia. The International 
List of causes of death does not provide for the separate tabulation 
of these several types. Indeed, the title itself is unsatisfactory ; the 
term " anemia " is very vague and is used very loosely indeed ; so 
much so, that it is probable that many fatal cases so diagnosed 
would not be reported under this title heading if blood examina- 
tions had been made. In many cases the deaths here tabulated 
result either from acute or chronic secondary anemias, and if all 
of the data for correct classification had been at hand, they would, 
doubtless, have been assigned to many other causes, prominent 
among which are malarial fever, rheumatic fever, syphilis, malig- 
nant growths, the autogenous poisonings resulting from various 
chronic diseases, and indeed in some cases, to traumatic agencies. 

It will, therefore, be understood that the title "anemia, chloro- 
sis" relates only in part to proved fatal cases of the two forms of 
primary or essential anemia known as chlorosis and pernicious 
anemia. 

It will be noted that in the Metropolitan Industrial experience 
there has been little change in the death rate during the six year 
period 1911 to 1916. A slight upward trend is shown. This cor- 
responds with the general population experience as shown by the 
Census Office reports on mortality statistics. 

" Other Chronic Poisonings." 

Only 164 deaths were charged to this title (No. 59 of the Inter- 
national List of Causes of Death) during the period 1911 to 1916. 
These deaths were cases reported as due chiefly to chronic morphin- 
ism, opium poisoning and coeainism. It should be understood that 
the chronic occupational poisonings are not classified here ; nor are 
any of the acute poisonings, whether occupational or not. The 
chief interest in the figures attaches to the fact that during the first 
four years of the sexennium there was little change in the death 



268 MORTALITY STATISTICS OF INSURED WAGE EARNERS. 

rate. In 1915, however, there was a considerable increase, but in 
1916 the death rate dropped very materially. This corresponds 
with the general population experience, and it may be presumed 
that the very pronounced decrease in the death rate in 1916 was 
due to the enforcement of legislation covering the sale of habit- 
forming drugs. 

Encephalitis. 

Under this vague and indeterminate heading, 519 deaths were 
classified. This corresponds to a death rate of 1.0 per 100,000 
exposed. There has been a steady downward trend in the mor- 
tality charged to this disease throughout the period and the rate 
for the final year, 1916 (.8), represents an apparent decline of 
33^ per cent, from that for the first year, 1911 (1.2). This appar- 
ent decline should be construed as having very little significance 
other than to serve as an evidence of the increasing accuracy with 
which causes of death are being reported year after year. Without 
question many deaths are being added to the totals classified as due 
to tuberculous meningitis and to the various forms of violence on 
account of the growing tendency to specify the primary factor in 
cases of terminal encephalitis. This downward trend in the appar- 
ent death rate is also seen in the experience of the expanding Reg- 
istration Area. 

Meningitis. 

Four thousand one hundred and seventy-one (4,171) deaths were 
classified under "meningitis" during the period 1911 to 1916. 
This title, unfortunately, is a composite one and includes not only 
the condition known as "simple meningitis," which is usually a 
terminal condition in other primary diseases, but also the epidemic 
cerebrospinal type which is an infectious disease. Of the 4,171 
deaths, 3,348 were returned as due to the former group of condi- 
tions such as "simple meningitis," "meningitis," without further 
qualification, "cerebral meningitis," "spinal meningitis," and 823 
deaths were reported as due to cerebrospinal fever. 

The statistical tabulation of deaths returned under the first group 
is hardly worth while, because such reports are but partial reports, 
and as such, figures relating to them are bound to be misleading. 
Experience and tests have shown that over three-fourths of the 
deaths returned in this manner were really primarily due to other 
conditions, chief among which are tuberculous meningitis, syphilis, 



MISCELLANEOUS DISEASES AND CONDITIONS. 



269 



cerebrospinal fever and diseases of the ears. The 3,348 deaths just 
referred to represent cases in which it was not possible to secure 
information either as to the type of "meningitis" or the name of 
the disease or form of violence of which it was a sequela. 

Cerebrospinal Fever. — The chief interest in the study of menin- 
gitis statistics is centered on the 823 deaths relating to cerebro- 
spinal fever, or to epidemic cerebrospinal meningitis as it is often 
called. This is an acute infectious disease caused by an organism 
known as the diplococcus mtracellularis meningitidis. While it 
is marked by fever and by inflammation of the cerebral and the 
spinal meninges, its place in a statistical classification should be 
among the specific infectious diseases rather than among those of 
the nervous system, where it is at present placed. 

In the first year of the sexennium to which this report relates, 
no effort was made to segregate the deaths from this disease. The 
two tables which follow relate, therefore, to a quinquennial period, 
1912 to 1916. The first of these tables, which is given immediately 
below, shows the sex, color and age distribution of the mortality 
among the insured for this period. 

TABLE 174. 
Mortality from Cerebrospinal Fever, Classified by Color, Sex and by 

Age Period. 

Death Bates per 100,000 Persons Exposed. 1912 to 1916. 

Experience of Metropolitan Life Insurance Company. Industrial Department. 





Persons. 


WWte. 


Colored. 


Age Period. 


Males. 


Females. 


Males. Females. 


All ages — one and 
over 


1.8 


2.1 


1.2 


3.8 2.4 






1 to4 

5 to 9 

10 to 14 

15 to 19 

20 to 24 

25 to 34 

35 to 44 

45 to 54 

55 to 64 

65 to 74 

75 and over. . 


7.2 

2.6 

1.8 

1.7 

1.1 

.8 

.7 

.8 

.3 

.4 


8.0 

2.4 

1.6 

2.4 

1.0 

.8 

.7 

.9 

.4 

.3 


6.3 
2.1 
1.3 
.7 
.8 
.5 
.4 
.2 
.1 
.6 


9.2 
7.3 
4.9 
5.0 
3.5 
2.7 
1.6 
3.4 
.7 


6.9 
4.9 
4.8 
1.7 
1.9 
1.3 
1.5 
2.1 
1.6 



There were 823 deaths either originally reported or finally iden- 
tified in our experience during the quinquennium 1912 to 1916 as 



270 



MORTALITY STATISTICS OF INSURED WAGE EARNERS. 



due to cerebrospinal fever. Over one-third of these were deaths of 
children 1 to 4 years of age ; over one-half were under 10 and about 
two-thirds under 15. The mortality for males in both the colored 
and white experience was very considerably in excess of that for 
females and for each sex the death rate for the colored experience 
was heavily in excess of that for the white. 

The following table shows the trend of the death rate for cerebro- 
spinal fever during the quinquennial period 1912 to 1916. It will 
be noted that the decline was a continuous one for the first four 
years of the quinquennium, that is, from a maximum of 3.0 per 
100,000 exposed in 1912 to a minimum of 1.3 in 1915. This was 
followed by a slight increase to 1.5 in 1916. The experience for 
the insured corresponds fairly well with that for the general popu- 
lation except that for 1916 the latter, with a rate of 2.1 per 100,000 
population, shows more of an excess over the 1915 rate than is in 
evidence for the corresponding year in the Metropolitan experience. 

TABLE 175. 
MOKTALITT FEOM CEEEBROSPINAL FeVER, CLASSIFIED BY COLOR AND BY SEX. 

Death, Bates per 100,000 Persons Exposed. Single Years 

in Period 1912 to 1916. 

Experieiice of Metropolitan Life Insurance Company. Industrial Department. 





Persons. 


White. 


Colored. 


Year. 


Males. 


Females. 


Males. 


Females. 


1912tol916 


1.8 


2.1 


1.2 


3.8 


2.4 


1916 

1915 

1914 

1913 

1912 


1.5 
1.3 
1.5 
1.7 
3.0 


1.9 

1.8 
1.8 
1.8 
3.1 


1.2 
1.1 
1.1 
1.4 
1.5 


2.0 

.9 

2.7 

3.4 

10.4 


1.4 
.8 
1.1 
2.3 
6.6 



Locomotor Ataxia. * 

The most important causative factor in locomotor ataxia is syph- 
ilis, and, in fact, some of the best authorities now say that the 
disease never originates without syphilis. On this account deaths 
certified as due to locomotor ataxia should be considered in 
relation to syphilis, and in Appendix C there will be found 
quotations of the number of deaths charged to syphilitic in- 
fection in which it had been definitely certified by physicians 
that the syphilitic origin of locomotor ataxia had been attested by 

*See also syphilia, page 237. 



MISCELLANEOUS DISEASES AND CONDITIONS. 271 

Wassermann reactions. On account of the growing tendency of 
physicians to certify primary causes, and on account of the practise 
among some statistical offices of requesting physicians to certify 
definitely to the luetic origin of deaths ascribed to locomotor ataxia, 
the death rate for locomotor ataxia is showing an apparent decline. 
This decline has been continuous in the present experience for in- 
sured wage earners throughout the last four years of the six year 
period covered by this report. This is not in agreement with the 
death rates shown for the expanding Eegistration Area in which 
for four of the six years there was no change. There was a decline, 
however, from 2.6, the 1915 rate in the general population, to 2.4 
per 100,000 population in 1916. The Eegistration Area death 
rates are considerably higher than those for the insured. This is 
accounted for, in part, by the age distribution of the two popula- 
tions. Well over one-third of the deaths from the disease occurs in 
the higher age periods where the policyholders do not comprise a 
very high proportion of the total number insured. 

Softening of the Brain. 

Under this heading, 488 deaths of Industrial policyholders were 
classified during the six year period 1911 to 1916. The death rate 
for the period was .9 per 100,000 exposed. Examination of the 
apparent trend of the death rate shows a practically continuous 
downward trend during the six years and the rate for 1916 (.7) 
is 58.3 per cent, of that for 1911. Softening of the brain is an 
extremely unsatisfactory statement of cause of death in that it is 
a secondary condition rather than a primary cause. This explains 
the apparent downward trend in the mortality which the figures 
for the years of the sexennium show. The fact is that in the later 
years registration offices have been querying this return, with the 
result that many deaths originally certified as due to softening of 
the brain have been registered, instead, under arteriosclerosis, em- 
bolism, thrombosis, and other diseases, as a result of more definite 
information so secured. The apparent decrease shown for the in- 
sured group corresponds to that shown for the general population. 

General Paralysis of the Insane. 

Two thousand two hundred and twenty-four (2,224) deaths of 
Metropolitan Industrial policyholders were classified as due to 



272 MOETALITY STATISTICS OF INSURED WAGE EARNERS. 

this disease during the six year period, 1911 to 1916. The death 
rate was 4.1 per 100,000 exposed. In view of the fact that the 
antecedent cause of general paralysis of the insane is now believed 
by the best authorities to be syphilis, a separate statistical treat- 
ment of the mortality from general paralysis is of little value. It 
has been decided, therefore, to treat it in connection with the study 
of syphilis, page 237. When this condition is reported jointly with 
syphilis, the death is classified as one primarily due to the latter, 
but very frequently indeed, physicians simply report "general 
paralysis of the insane," "dementia paralytica," "paresis," or 
"general paralysis" without stating specifically that these condi- 
tions occurred as the result of initial syphilitic infection. Since 
the International List of Causes of Death provides a separate title 
for general paralysis of the insane we have (in keeping with stand- 
ard practise) classified under general paralysis all deaths in which 
syphilitic origin was not definitely stated by physicians, except that 
in very many cases letters of inquiry were sent to physicians asking 
them whether they had knowledge of the existence of syphilis as a 
predisposing cause and, if so, whether its presence was shown by 
history or by tests. The replies in a great many instances gave us 
information on the strength of which many deaths originally cer- 
tified as due to general paralysis of the insane were ultimately 
classified under the heading of syphilis. 

Analysis of the apparent trend of the death rate among the 
Company's policyholders shows a very pronounced decrease for 
general paralysis of the insane. The death rate for 1916 (2.7 per 
100,000 exposed) is less than half that for 1911 (5.7) and with 
one exception there was a continuously declining death rate 
throughout the period 1911 to 1916. The declining rate shown for 
the Metropolitan experience is in marked contrast to the increasing 
mortality shown by the reports of the Census Bureau for the ex- 
panding Registration Area of the United States throughout the 
same period. It was not the custom in the Census Bureau during 
the period 1911 to 1916 to query reports of general paralysis for 
specific statements of the existence of syphilis. 

The color and sex incidence of the death rates for general paral- 
ysis of the insane is about the same as for sjrphilis. The death 
rates for males exceed those for females in the colored as well as in 
the white experience, and the rate for colored persons is very much 
higher for each sex than that for the whites. 



MISCELLANEOUS DISEASES AND CONDITIONS. 273 

Convulsions. 

Five hundred and fifty-nine (559) deaths were charged to "con- 
vulsions '' in this experience. The International List of Causes of 
Death devotes two title headings to this subject, one of which is 
confined to deaths of children under 5 years of age and the other 
to persons 5 years of age and over. The 461 deaths of children 
under 5 years classified under this cause are assigned thereto only 
in cases where it was impossible to secure more definite iniorma- 
tion which would justify the inclusion of such deaths under more 
definite and satisfactory statistical headings. Convulsions in 
young children represent a symptom-complex of some other condi- 
tion — in the majority of cases such diseases as diarrheal complaints, 
the pneumonias, and the several forms of meningitis. Only 98 
deaths of persons 5 years and over were charged to convulsions 
during the six year period. These also represent cases which were 
assigned to this title only when it was not possible to obtain defi- 
nite data which would justify their classification elsewhere. When 
such information is obtained, these deaths are usually transferred, 
in cases of women of childbearing age, to puerperal causes, and in 
adult males to the various nervous diseases or to some form of 
traumatism. 

The death rate for convulsions is declining, which is a manifesta- 
tion of improvement in statements of cause of death rather than an 
indication of changed condition as to the incidence of fatal cases 
of "convulsions." 

" Other Diseases of the Nervous System/' 

Under this heading of the International List of Causes of Death 
are classified a very considerable number of nervous diseases which 
are not covered statistically by any other title relating to the vari- 
ous diseases of the nervous system and the organs of special sense. 
The title, therefore, is a residual one and many of the diseases 
listed under it are so dissimilar to others so listed, that the only 
relationship lies in the fact that they all affect the nervous system. 
Under this heading the following, chiefly, were reported as causes 
of death: acute hydrocephalus, anemia of brain, cerebral tumor, 
cretinism, disease of brain (nature not specified and unobtainable 
on inquiry), idiocy, imbecility, Jacksonian epilepsy, nervous ex- 
haustion, nervous prostration, neurasthenia, sclerosis of brain, 
19 



274 MORTALITY STATISTICS OF INSURED WAGE EARNERS. 

tetany and a few others. Many of the diseases listed under this 
title are really of syphilitic, or more or less remote traumatic, origin. 
These deaths would have been so classified if accurately reported. 
The death rate from this group of causes in the present experience 
shows a slight downward trend. This is due to increasingly specific 
statements of cause of death resulting from the widespread cam- 
paign carried on by practically all registration offices with a view 
to securing accurate reports from physicians. The tendency in the 
expanding Eegistration Area is also a downward one, which is 
attributable, doubtless, to the same cause. 

The number of deaths recorded under this residual title during 
the period 1911 to 1916 was 1,349, corresponding to a death rate of 
2.5 per 100,000 exposed. 

Diseases of the Ears. 

In the great majority of the fatal cases of ear disease otitis media 
is the primary factor. There were 962 deaths charged to ear dis- 
eases in the Metropolitan Industrial experience during the period 
1911 to 1916. The death rate was 1.8 per 100,000 exposed. The 
prevailing rate throughout the years of the sexennium has changed 
very little from year to year. This corresponds with the expe- 
rience in the expanding Eegistration Area of the United States, 
although in the latter experience group the rate in recent years has 
been much higher than in the years covering the first quinquennium 
of the present century. There has not been an actual increase in 
the fatal cases of ear disease, probably, to the extent indicated by 
these rates. On the other hand, hundreds of physicians who, in 
earlier years would have certified fatal cases of otitis media as due 
to the terminal condition, meningitis, have been returning such 
cases in more recent years, under the stimulus of educational propa- 
ganda, as "otitis media." 

Pericarditis. 

Under this heading the deaths of 634 Metropolitan Industrial 
policyholders were recorded during the period 1911 to 1916. The 
corresponding death rate was 1.2 per 100,000 exposed. The trend 
of the death rate is downward. In 1911 the rate was 1.4, in 1912 
and 1913 it was 1.3 and for each of the three remaining years of 
the sexennium it was 1.0 per 100,000. The apparent downward 



MISCELLANEOUS DISEASES AND CONDITIONS. 275 

trend of the death rate in the Metropolitan experience corresponds 
fairly well to that in the Eegistration Area. Probably the decline in 
each experience is more apparent than real. Secondary pericarditis 
is, more and more, being recorded under the primary infection. The 
disease is usually the result of pyogenic infection or it arises by 
extension of inflammation from contiguous organs. As a primary 
condition it is extremely rare. It is caused, in addition to the 
lesions noted above, by rheumatism, traumatism, and indeed in 
some cases, by tuberculosis. The more frequent mention of pri- 
mary rheumatic fever and other causative factors on forms pro- 
vided for reporting causes of death is perhaps the chief factor in 
the apparent decline of the pericarditis death rate. 

Under this heading are also classified certain other diseases of 
the pericardium, namely, hydropericardium, hemopericardium and 
pneumopericardium. 

Acute Endocarditis. 

Under this heading are classified first, all deaths reported defi- 
nitely as caused by acute endocarditis or acute myocarditis ; second, 
all deaths of persons under 60 years of age for whom "endocar- 
ditis" (without qualification) or "myocarditis" (without qualifi- 
cation) were returned as the cause of death;' third, cases of in- 
fective endocarditis, malignant endocarditis and septic endocarditis 
reported with no additional information as to primary causative 
factors. The title heading "acute endocarditis" as used in the 
International List of Causes of Death is a distinct misnomer, since 
under this title are classified also deaths from myocarditis which 
is an inflammation of the myocardium or muscular walls of the 
heart, whereas endocarditis is an inflammation of the endocardium 
or lining membrane of the heart. A better title heading for the 
conditions included here would be acute infectious endocarditis and 
myocarditis. 

Nevertheless, 5,080 deaths of Metropolitan Industrial policy- 
holders were classified under this heading during the sexennium 
1911 to 1916. The death rate for the period was 9.4, and although 
there has been no pronounced change from year to year, there has 
been a slight upward trend in the rate. The annual average for 
the last three years of the six year period is much higher than that 
for the first three years. This is difficult to account for in view 
of the fact that for almost all of the other unsatisfactory and indefi- 



276 MOKTALITY STATISTICS OF INSUEED WAGE EARNERS 

nite titles we have observed a tendency toward an apparent decrease 
in the death rate. This title is unsatisfactory because instances 
are very rare indeed in which acute endocarditis occurs as a pri- 
mary disease. Consequently, whenever it is reported without state- 
ment of any other morbid condition, the presumption is that the 
name of the etiological entity which was responsible for this condi- 
tion was not mentioned by the physician. In the expanding Regis- 
tration Area of the United States since 1911 there has been a slight 
upward trend also in the death rate for acute endocarditis. Know- 
ing as we do that we should expect the opposite trend in common 
with that for other indefinite statements, the reason for the increase 
in the rate must be sought elsewhere. It is possible that the num- 
ber of forms of the disease which are encountered as primary fac- 
tors is actually increasing. This may be true especially of cases in 
which malignant or infectious endocarditis is in evidence as a pri- 
mary disease of the heart lining or valves. However this may be, 
we are face to face with the situation that this is almost an isolated 
instance of an apparent increase in the death rate for an unsatis- 
factory title. 

Embolism and Thrombosis. 

Under this heading are classified reports of embolism and of 
thrombosis which appear with no statement as to primary cause. 
It should be distinctly understood, however, that deaths from puer- 
peral embolism and from embolism due directly to postoperative 
conditions are not classified under this heading, but in the first in- 
stance under the puerperal state, and in the second under the title 
representing the cause for the relief of which the operation was 
performed. 

One thousand one hundred and ninety-two (1,192) deaths were 
classified as due to embolism and thrombosis in this experience 
during the period 1911 to 1916. The corresponding death rate 
was 2.2 per 100,000 exposed. The general trend of the mortality 
throughout the period has been upward. There has been no pro- 
nounced change, however. The same trend is observed in the fig- 
ures for the expanding Eegistration Area during the corresponding 
period. In the Metropolitan experience the death rate for the 
colored exposure for the period as a whole (2.7) was in excess of 
that for white policyholders (2.1) ; the rate for white females (2.4) 
was higher than that for white males (1.8) ; for colored lives, how- 



MISCELLANEOUS DISEASES AND CONDITIONS. 277 

ever, the mortality among males and females was about the same, 
namely, 2.8 for the former and 2.7 for the latter. 

Diseases of the Larynx. 

The greater part of the 594 deaths which were classified under 
this heading during the period 1911 to 1916 were reported either 
as due to laryngismus stridulus, laryngitis, edema of glottis or 
spasmodic croup. The death rate for the period was 11 per 100,- 
000 exposed and the general trend throughout the sexennium has 
been slightly downward. This is also true of the expanding Eegis- 
tration Area experience. It frequently happens that deaths re- 
ported by physicians under the several terms classified under " dis- 
eases of the larynx" represent cases which were actually of diph- 
theritic origin. This applies particularly to deaths reported from 
" laryngitis " which were caused actually by diphtheritic, fibrinous, 
membranous or pseudomembranous laryngitis, but which were not 
so stated in the original return of the physician. Much of the 
apparent decline in the death rate for diseases of the larynx is 
doubtless due to the growing tendency of the medical profession to 
give more explicit statements of these causes, thus enabling statis- 
tical ofiices to classify them as deaths caused by diphtheria. 

Pulmonary Congestion, Pulmonary Apoplexy. 

Under this heading 939 deaths of Metropolitan Industrial policy- 
holders were classified during the period 1911 to 1916. The death 
rate for the sexennium was 1.7 per 100,000 exposed and the appar- 
ent trend, as shown by the figures relating to each year of the 
period, is distinctly downward. The same apparent downward 
trend is in evidence for the figures relating to the general popula- 
tion. In fact, it is more pronounced in the latter group than for 
the insurance experience. 

"Pulmonary congestion, pulmonary apoplexy" is an extremely 
unsatisfactory title from the standpoint of mortality statistics, be- 
cause the terms listed under it stand for conditions which are, 
almost altogether, mere complications or terminal symptoms of 
other diseases. It is, as a matter of fact, unfortunate that the 
rather considerable bulk of deaths reported in this way should be- 
come a part of the grand total recorded as due to diseases of the 
respiratory system. Many of these reports are received for cases 



278 MORTALITY STATISTICS OF INSURED WAGE EARNERS. 

in which the return is "pulmonary edema" or "pulmonary con- 
gestion/' and in which these conditions were terminal to cases of 
cardiac, renal or other diseases. The apparent decline in the death 
rate both among the insured group and in the general population 
experience is accounted for largely by better certification of primary 
diseases. 

The great majority of the deaths charged to this title were re- 
ported as due to pulmonary apoplexy, pulmonary congestion, pul- 
monary edema, hypostatic pneumonia and terminal pneumonia. 

Asthma. 

Under this title were classified the very considerable total of 
1,594 deaths during the sexennium 1911 to 1916. This corre- 
sponds to a death rate of 3,0 per 100,000 exposed. There has been 
a continuous decline in the rate throughout the years which con- 
stitute the period covered by this experience. The rate for the final 
year, 1916 (2.5), represents a decline of 30.6 per cent, from that 
shown for the earliest year, 1911 (3.6). This decline is not in 
evidence in the published figures for the general population, for 
which an almost uniform death rate is exhibited throughout the 
sexennium. The apparent decline shown in the figures for the 
insured group is due, in considerable part, to the rather rigid cen- 
sorship exercised concerning reports of " asthma " from the mining 
districts, with the result that many of these returns have been iden- 
tified as relating to cases of miners' asthma. These deaths are classi- 
fied under another title of the International List of Causes of Death. 
A number of these reports, moreover, would have been classified as 
cardiac asthma and assigned to organic diseases of the heart, and 
still others would have been assigned to Bright's disease as cases of 
renal asthma, if strictly accurate returns had been made. The 
deaths, therefore, which go to make up this total of 1,594 fatal cases 
represent, for the most part, reports of "asthma," without qualifi- 
cation, and also returns of " bronchial asthma " concerning both of 
which no additional data were available. The title is very unsatis- 
factory because it is intended to be limited to the disease known as 
bronchial or spasmodic asthma. Unfortunately the term "asthma" 
is used loosely by physicians in other conditions associated with 
dyspnea. In the Metropolitan experience the death rate for the 



MISCELLANEOUS DISEASES AND CONDITIONS. 279 

colored exposure (6.0) is more than double that for white persons 
(2.5). There is no marked sex incidence shown among the insured. 

" Other Diseases of the Respiratory System." 

Under the above heading are classified a considerable number of 
terms which are not assignable to any of the diseases of the respira- 
tory system for which a separate statement of mortality is provided 
in the International List of Causes of Death. It is known as a 
" residual " title, and like all others of this kind, it provides for the 
classification of a number of vague and indeterminate reports. 

It should be understood that tuberculous conditions, if known, 
are not classified under this title heading. In the Metropolitan 
experience the majority of the deaths classified here were reported 
as follows, there being no further definitive data available : abscess 
of lung, chronic pneumonia, " disease of lung," hemoptysis, hemor- 
rhage of lung, interstitial pneumonia, miner's asthma, and pneu- 
mokoniosis. 

Under this heading 888 deaths of Metropolitan Industrial policy- 
holders were registered during the period 1911 to 1916, correspond- 
ing to a death rate of 1.7 per 100,000 exposed. Comparison of the 
death rates for the several years constituting the six year period 
shows a marked downward trend, to which no significance whatever 
should be attached except as an evidence of the increasing accuracy 
of reporting causes of death and of the greater care with which 
these reports are inspected from year to year. The result is that 
reports of the very vague and indeterminate conditions listed under 
this title are being to a greater extent, year after year, transferred 
to more specific and satisfactory headings. This apparent down- 
ward trend in the death rate is also shown in the Census reports 
covering the mortality of the general population. 

Diseases of the Pharynx. 

One thousand one hundred and fifty-three (1,153) deaths of 
Industrial policyholders were reported from diseases of the pharynx 
during the six year period 1911 to 1916. The death rate for the 
sexennium was 3.1 per 100,000 exposed. The general trend of the 
mortality among the insured during the sexennium was upward. 
This was practically continuous. The minimum was shown for the 
earliest year, 1911 (1.6), and the maximum for the latest year. 



280 MORTALITY STATISTICS OF INSURED WAGE EARNERS. 

1916 (2.6), The same rising tendency of the death rate is shown 
by the figures for the general population. There was no pro- 
nounced color incidence in the Metropolitan experience although 
the rate for colored policyholders (3.4) exceeded slightly that for 
the white (2.1). The number of deaths of colored persons in- 
volved, however (159), was rather too small to be significant. 
Among the white insured the death rate for males (2.5) exceeded 
that for females (1.7) ; among the colored policyholders the rate 
for the females (2.6) was, on the other hand, higher than that for 
males (2.1). 

The greater part of the deaths charged to diseases of the pharynx 
were reported as follows: ^''disease of throat," Ludwig's angina, 
pharyngitis, quinsy, tonsillitis, or Vincent's angina. 

"Other Diseases of the Stomach {Cancer Excepted)."' 

The very considerable total of 4,921 deaths of Industrial policy- 
holders was reported as due to the various diseases and conditions 
which must be classified under the above title heading according to 
the stipulations of the International List of Causes of Death. This 
number of deaths corresponded to a death rate of 9.1 per 100,000 
exposed. There has been a continuous decline, however, through- 
out the six years covered by this report, from a maximum of 11.0 
for 1911, the earliest year, to a minimum of 7.6 for 1916, the latest 
one. An even more pronounced downward trend has been shown 
by the figures for the general population during the same period. 
The apparent decrease in the death rate is due to more accurate 
reporting of causes of death in the later years as compared with the 
earlier ones, together with more rigid questioning of the reports on 
the part of registration offices. 

Under this title are listed such terms as: gastritis, gastric ca- 
tarrh, " disease of stomach," " acute indigestion," " indigestion " 
and a number of others which, as a rule, are worse than worthless 
as statements of the primary cause of death. These terms are used 
carelessly when they relate to various fatal affections in which in- 
flammation or irritation of the stomach is a complication. Deaths 
so reported are found on investigation, very frequently, to be charge- 
able to such conditions as alcoholism, organic heart disease, gastric 
ulcer, gastroenteritis, and other diseases and conditions rather than 
to the above title. As is apt to be the case with these residual 



MISCELLANEOUS DISEASES AND CONDITIONS. 281 

titles., where careless and incompetent reporting of cause of death 
is so important a factor in influencing the death rate, the rate for 
colored policyholders is very greatly in excess of that for whites. 
In the Metropolitan experience the actual number of deaths of col- 
ored persons assigned to " other diseases of the stomach " was 1,563 
with a corresponding death rate of 23.3 per 100,000 exposed. 
There were 3,358 deaths of white insured with a rate of 7.1 or less 
than one third the rate for the colored. There was no marked dif- 
ference in the rates for males and females among the whites, the 
rate for the former being 6.9 and for the latter 7.3. Among the 
colored policyholders, however, the mortality among the females 
was considerably in excess of that among the males (25.6 as com- 
pared with 20.6). 

The terms which follow will indicate the manner in which the 
majority of the deaths charged to this title were reported in the 
Metropolitan experience. It should be understood that in each 
case no further information was available on the basis of which it 
could be classified under a more definite and satisfactory title: 
abscess of stomach, catarrh of stomach, catarrhal gastritis, conges- 
tion of stomach, "disease of stomach" (unqualified), dyspepsia, 
gastritis, hemorrhage of stomach, indigestion, acute indigestion, 
and pyloric stenosis (noncancerous or unqualified). Although it 
is plainly indicated in the title heading that cancer of the stomach 
is not included here, it is, perhaps, well to emphasize the fact by 
restating it and to direct attention to Title No. 40 (cancer and 
other malignant tumors of the stomach and liver) under which 
deaths from malignant gastric growths are classified. It is possible 
only to speculate as to how much unrecognized cancer is concealed 
under the title " other diseases of the stomach." 

Biliary Calculi. 

Under the above title were classified 1,591 deaths in the Metro- 
politan Industrial experience during the six year period 1911 to 
1916. The corresponding death rate was 3.0 per 100,000 exposed. 
A very slight upward trend was shown throughout the six year 
period. This same upward trend was shown for the general popu- 
lation experience. In both experiences it is accounted for, in all 
probability, by increasing precision in statement of causes of death 
rather than by any actual increase in deaths caused by biliary cal- 



282 MOETALITY STATISTICS OF INSURED WAGE EARNERS, 

culi. For this disease the death rate of white persons is consid- 
erably higher than that for the colored, while the rate for females 
in both the white and colored experiences is very much higher than 
for males. White females show a death rate of 4.9 per 100,000 
exposed for the period 1911 to 1916, which is almost five times that 
for white males (1.0) ; for the colored the female rate (3.4) is 
double that for the males (1.3). 

The greater part of the deaths charged to biliary calculi were 
reported in the Metropolitan experience under the following terms : 
biliary calculus, biliary colic, cholelithiasis, and gall stones. 

"Other Diseases of the Liver." 

Under this heading the very considerable total of 3,181 deaths 
were classified during the sexennium 1911 to 1916. The death 
rate was 4.1 per 100,000 exposed for the period. Included here are 
the various noncancerous, nontuberculous and nonsyphilitic hepatic 
and gall-bladder affections for which the International List of 
Causes of Death does not provide a separate classification. The 
causes of death assigned to this title were reported, in the main, as 
follows: abscess of liver, atrophy of liver, cholemia, cholangitis, 
cholecystitis, disease of liver (unqualified), hepatitis, hypertrophy 
of liver, icterus, and jaundice. 

There has been a fairly consistent decline in the death rate 
throughout the period covered by this report. A similar downward 
tendency is shown in the reports covering the mortality for the gen- 
eral population experience although the downward trend there is 
not as marked as that shown for the insured. In each case the 
decline in the death rate is doubtless due more to increasing accu- 
racy in reporting than to any change in conditions covering actual 
fatal cases resulting from the diseases classified under this title. 
In the Metropolitan experience the colored exposure shows a death 
rate considerably in excess of the white. The sex incidence, how- 
ever, is different for the two races. Among white insured wage 
earners the rate for females was 4.4 per 100,000 exposed, as com- 
pared with 3.0 for white males. Colored lives, however, show a 
higher rate for males (6.4) than for females (5.8). 

Simple Peritonitis (Nonpuerperal) . 
Under this very unsatisfactory heading 1,013 deaths were re- 
ported in the Metropolitan experience during the six year period 



MISCELLANEOUS DISEASES AND CONDITIONS. 283 

1911 to 1916. The death rate was 1.9 per 100,000 exposed. It is 
desired at this point to emphasize the fact that no case was classi- 
fied under this heading until every possible effort had been made to 
ascertain the primary cause of the "peritonitis." Experience 
shows that a very large majority of the deaths which physicians 
certify as due to "peritonitis" are, in fact, primarily caused by 
tuberculous peritonitis, appendicitis, traumatism, and both non- 
puerperal and puerperal diseases of the female genitals. Primary, 
idiopathic peritonitis is rare and each report of "peritonitis" is a 
suspicious one for which vital statisticians usually seek a correction 
before tabulating the death under this heading. The 1,013 deaths 
charged to this title, therefore, represent, in the main, a residue of 
those originally certified as caused by "peritonitis" and concern- 
ing which no more definite information could be obtained. No 
significance is to be attached to the declining death rate shown for 
the insured in the later years covered by this report as compared 
with the earlier ones. The decline registers simply the increasing 
tendency to report cases complicated by peritonitis under the pri- 
mary cause rather than under the terminal symptom. A corre- 
sponding apparent decline in the death rate of the general popula- 
tion is shown in the reports covering its mortality. The decrease 
is traceable, to a very great extent, to the same cause. Colored 
lives show a mortality more than triple that in evidence for the 
whites (4.7 per 100,000 exposed as compared with 1.5). In the 
white experience the rate for females (1.9) is nearly double that 
for males (1.0) ; in the colored experience the mortality assigned to 
this cause for females was Q.&, which is almost treble that for col- 
ored males (2.4). 

Acute Nephritis. 

Numerically, acute nephritis is an important cause of death in 
the Industrial experience of the Metropolitan Life Insurance Com- 
pany, no less than 5,120 deaths having been charged to it during 
the sexennium 1911 to 1916. The corresponding death rate was 
9.5 per 100,000 exposed. This is another one of the causes of death 
for which the International List provides a separate title heading, 
but which by no means constitutes a satisfactory statement of cause 
of death. In the majority of deaths in which acute nephritis is a 
factor, it is a secondary condition. When it appears as the sole 
statement of cause of death the report is always more or less sus- 



284 MORTALITY STATISTICS OF INSURED WAGE EARNERS. 

picious, the strong presumption being that the primary causative 
factor has been omitted in the statement of the physician. Among 
the principal causes of acute nephritis are exposure to cold, as well 
as typhoid fever, malaria and syphilis. Acute poisonings also 
often bring on this disease. Whenever it is reported, without 
qualification, in connection with the death of a woman of child- 
bearing age it is more than probable that the death is one that 
should, in reality, be classified under the head of those due to puer- 
peral causes. In children it is a frequent complication of the acute 
contagious or infectious diseases such as scarlet fever, measles, 
diphtheria and even chicken pox. The 5,120 fatal cases which are 
here ascribed to this disease represent a mere residue of those origi- 
nally reported as having been caused by "acute nephritis." During 
the latter half of the experience period particularly, there has been 
rigid inspection of such reports and many letters of inquiry for 
the primary cause have been sent out to physicians. The replies 
which have been received together with the growing tendency to 
report primary conditions are, more than any other factors, respon- 
sible for the decline in the death rate which is shown when com- 
parison is made of the rates for the first three and the last three 
years of the sexennium, 1911 to 1916. A similar apparent decline 
in the death rate is shown by the published figures for the general 
population; but this decline, like that for the Metropolitan Indus- 
trial experience, evidenced better reporting and improved methods 
of compiling causes of death rather than an actual decrease in the 
number of cases in which " acute nephritis " was the primary cause 
of death. 

On the basis of the 5,120 deaths that remain registered under 
this cause, the death rate for the colored exposure (17.9 per 100,000 
exposed) was more than double that for the whites (8.3). For 
white insured lives the mortality among males (9.2), was consid- 
erably higher than that for females (7.6). Among colored lives, 
however, there was little difference in the rates for the sexes, 18.0 
for males, as compared with 17.8 for females. 

"" Other Diseases of the Kidneys." 

Eight hundred and sixty-one (861) deaths of Industrial policy- 
holders were charged to "other diseases of the kidneys" during 
the period 1911 to 1916. This corresponds to a death rate of 1.6 



MISCELLANEOUS DISEASES AND CONDITIONS. 285 

per 100,000 exposed. No pronounced change is shown for any 
year of the period as compared with other years, the death rate 
being fairly stationary. This is also true in the general popula- 
tion experience, although the death rate for this group of diseases 
is slightly higher in the general population than among the insured. 
Comparison of color and sex rates among the policyholders shows 
that the mortality in the colored exposure, 2.4 per 100,000 exposed, 
was rather in excess of that for the white group (1.5). For white 
lives, however, the death rate for females (1.6) was a little higher 
than that for males (1.4) ; this is contrary to the experience in the 
colored exposure, for which the male rate was 2.8 as compared with 
2.0 for the females. 

Diseases of the Bladder, 

Under this heading 611 deaths of Metropolitan policyholders 
were classified during the period 1911 to 1916. The death rate for 
the period as a whole was 1.1 per 100,000 exposed; a fairly con- 
tinuous downward trend is in evidence throughout the period. It 
should be stated that this title does not include cancer of the blad- 
der, tuberculosis of the bladder, bladder conditions of gonococcic 
origin, nor vesical calculus. A decline in the death rate as shown 
for the Metropolitan experience is also in evidence, and even more 
pronounced, in that of the general population. This is due to the 
change of many reports to the titles that relate to gonococcus in- 
fection, to diseases of the prostate, and to cancer and tuberculosis. 
The great majority of the fatal cases classified under this title were 
reported as due to cystitis, retention of urine, rupture of the blad- 
der, tumor of the bladder (noncancerous or unqualified) and abscess 
of the bladder. The rate for colored lives (2.2 per 100,000 ex- 
posed) is more than double that for white lives (1.0) and for both 
the colored and the white experiences the death rate for males was 
about three times that for females. 

Diseases of tJie Prostate. 

The diseases of the prostate gland, exclusive of those certified as 
due to tuberculous, cancerous, syphilitic, or traumatic causes, were 
reported as causes of 1,162 deaths among Metropolitan Industrial 
policyholders during the sexennium to which this report relates. 
The corresponding death rate was 2.2 per 100,000 exposed. There 



286 MORTALITY STATISTICS OF INSURED WAGE EARNERS. 

was no pronounced variation during the six year period. The rate 
for the period as a whole and for each of the several years which 
constitute it, is lower than that for the general population. This 
is due to the fact that a very great majority of the deaths caused 
by prostatic troubles are those of men in the higher age groups. 
Ordinarily, very close to 90 per cent, of the mortality from these 
diseases is among men over sixty years of age. On account of the 
comparatively low exposure among the insured at these ages, a 
higher death rate is to be expected in the general population expe- 
rience. The mortality among colored men for the six year period 
was 7.7 per 100,000 exposed, which is almost double the rate for 
the white insured (4.3). 

Uterine Tumor {Noncancerous). 

Under this heading are classified all uterine growths which are 
not reported as due to cancer. The number of deaths charged to 
this cause in the Metropolitan Industrial experience during the 
sexennium 1911 to 1916, was 1,335, corresponding to a death rate 
of 2.5 per 100,000 exposed. Little change is shown throughout the 
period when the rates for the individual years are compared. The 
death rate in the general population experience is lower for each 
year of the period, but, like that for the insured, there is little fluc- 
tuation from year to year. The great bulk of deaths charged to 
this condition occurred between the ages of 25 and 55 years — in 
fact, 1,103 or 82.6 per cent, of the 1,335 deaths were those of women 
in this age group. The difference in the rates for the Metropolitan 
and the expanding Eegistration Area experience is accounted for 
largely by the different race composition of the two populations. 
The death rate among colored women is much higher than among 
the whites — over six times as high ; the rates for the two races being 
17.3 and 2.7 per 100,000 exposed respectively. The proportion of 
colored policyholders to the total number of policyholders is far 
greater than the proportion of the colored population of the ex- 
panding Eegistration Area is to its total population. We would, 
therefore, expect a higher death rate among the insured. 

" Other Diseases of the Uterus." 

Under this heading are classified deaths actually caused by non- 
cancerous, nontuberculous and nonpuerperal diseases of the uterus. 



MISCELLANEOUS DISEASES AND CONDITIONS. 287 

together with certain others which, if correctly certified, would have 
come under cancer, tuberculosis, or puerperal causes. The latter 
group are placed under the unsatisfactory title, "other diseases of 
the uterus " because all of the information which physicians might 
have given did not appear in their statements. The deaths classi- 
fied under this heading were returned, in the main, under one of 
the following designations: abscess of uterus, disease of uterus 
(with no further qualification), endometritis, inflammation of 
uterus, menopause, metritis, pelvic abscess, pelvic cellulitis and 
prolapse of uterus. 

There were 786 such reports during the period 1911 to 1916, cor- 
responding to a death rate of 1.5 per 100,000 exposed. Rather a 
pronounced apparent downward trend is shown, which means that 
the growing tendency to make full and complete reports has brought 
about more certifications under the head, chiefly, of diseases inci- 
dental to pregnancy and childbirth. 

Salpingitis, Other Diseases of the Female Genital Organs. 

One thousand seven hundred and eighty-two (1,782) deaths of 
insured women were classified under this heading during the period 
1911 to 1916. The death rate was 3.3 per 100,000 exposed, and 
there was very little variation throughout the sexennium. Com- 
parison with the figures for the general population shows that, 
while the death rate for the latter was the lower, the same absence 
of any material fluctuation from year to year is to be observed. 
The comparatively high death rate among insured women is due, 
largely, to the fact that there is a higher proportion of colored 
women among them. In the experience for the insured, the mor- 
tality among colored women from these diseases has been about 
four times that for the whites. Practically 90 per cent, of the 
deaths are those of women between the ages of 20 and 50 years. 

Under this heading are classified all deaths caused by the non- 
venereal, noncancerous, nontuberculous, and nonpuerperal diseases 
of the female genital organs for which separate headings are not 
provided by the International List of Causes of Death. The great 
majority of the deaths classified under this heading were reported 
under one of the following terms: abscess of Fallopian tube, ab- 
scess of ovary, disease of genital organs (unqualified), disease of 
ovary (unqualified), disease of Fallopian tube (unqualified), in- 



288 MORTALITY STATISTICS OF INSURED WAGE EARNERS. 

flammation of Fallopian tube, inflammation of ovary, ovaritis, pus 
tube, pyosalpingitis, rupture of tube, salpingitis, and tubo-ovarian 
abscess. A large number of these were, undoubtedly, either of 
gonoeoccie or puerperal origin. They were not so defined by physi- 
cians, however, and the 1,783 cases classified under "salpingitis, 
other diseases of the female genital organs " are those which could 
not be definitely identified as deaths primarily due to gonorrhea or 
to puerperal causes. 

Oangrene. 

Under this very unsatisfactory heading 681 deaths of Metro- 
politan Industrial policyholders were classified during the six year 
period 1911 to 1916. This corresponds to a death rate of 1.3 per 
100,000 exposed. The death rate shows an apparent decline 
throughout the period. This is due, largely, to improving certi- 
fication of causes of death whereby primary causative factors in 
cases of gangrene are being certified by physicians to a greater 
extent year after year. In consequence, deaths in which gangrene 
appears as a complication are being classified, more and more, under 
the diseases of which gangrene is a complication. The same appar- 
ent decline in the death rate is in evidence for the general popula- 
tion, and this decline is doubtless due to the same reason as that 
which is shown for the Industrial experience. The death rate for 
the general population is considerably higher, which is to be ex- 
pected on account of the age distribution of the two populations, 
if for no other reason; for a very great majority of the deaths 
charged to this title are those of persons over 60 years of age, and 
this class does not constitute as great a proportion of the Metropoli- 
tan exposure as it does of that of the general population. Again, 
a report of "gangrene" is not accepted by the Metropolitan Sta- 
tistical Bureau for classification, without investigation as to the 
primary cause. In consequence of this rather rigid censorship, a 
very considerable number of deaths originally certified as due to 
gangrene have been transferred to other titles, chief among which 
are diseases of the arteries, embolism and thrombosis, diabetes and 
many of the several titles which come under the general class head- 
ing " External Causes." 

Old Age. 

This is one of the most unsatisfactory title headings in the Inter- 
national List of Causes of Death. The several terms listed under 



MISCELLANEOUS DISEASES AND CONDITIONS. 289 

this title, such as, " senility," " old age," " senile debility," " senile 
degeneration," " senile weakness " and others have too often been 
used in cases of old people who died of more or less well defined 
organic disease. Fortunately, however, this practice is steadily 
falling into disuse and the death rate for old age is seemingly de- 
clining. The decrease in the death rate in 'the Metropolitan In- 
dustrial experience is significant, therefore, only as it represents an 
improvement in the quality of the returns from year to year and 
in the censorship exercised in classifying causes of death. A simi- 
lar decrease in the apparent death rate for old age is in evidence in 
the mortality reports for the general population and is to be at- 
tributed to the same causes. The published death rate has declined 
in the expanding Registration Area from 50.4 in 1900 to 17.0 in 
1916. 

Three thousand four hundred and eighty (3,480) deaths of 
Metropolitan Industrial policyholders were charged to this condi- 
tion during the six year period 1911 to 1916; this corresponds to 
a death rate for the period of 6.5 per 100,000 exposed. The crude 
death rate for old age among the insured is, of course, much lower 
than that shown for the Registration Area, the obvious reason 
being the difference in the age distribution of the two populations. 
A much smaller exposure proportionately of old people is found 
among the insured. The death rate for colored lives during the 
period (8.9) is higher- than that for white lives (6.1) and for each 
color class a higher death rate was reported for females than for 
males. 

In this connection it is of interest to note that the decrease in 
the death rate for old age is responsible for a considerable part of 
the supposed increase in the death rates of some of the " degenera- 
tive diseases." The explanation is that the great majority of the 
deaths which, under conditions of five, ten, or fifteen years ago, 
would have been returned as due to " old age " or its synonyms, are 
now being reported by more careful physicians under such head- 
ings as cerebral hemorrhage, arteriosclerosis, organic heart dis- 
ease, etc. 

Ill-Defined Diseases. 

Under this heading of the International List of Causes of Death 
are classified all reports which are not returned in such a way as 
to permit more satisfactory statistical assignment. The great ma- 
20 



290 MORTALITY STATISTICS OF INSURED WAGE EARNERS. 

jority of the deaths classified under this heading consists of cases 
in which either a complete diagnosis was not made or reported, or 
in which the cause of death was absolutely unknown or was returned 
as "unknown." In some instances there was no medical attend- 
ance. It should be definitely understood that none of the deaths 
classified under this title in this report was so assigned without 
every effort having been made to obtain a more definite report. 
Many hundreds of cases in which the vague and indeterminate ex- 
pressions listed under this class were encountered in the original 
certifications of physicians and coroners were ultimately classified 
under more definite headings as a result of corrections made by 
those who gave the original reports. The general improvement in 
cause of death certification and the yearly growing number of these 
corrected returns are the sole explanations for the declining death 
rate which is in evidence for this class, both for the insured and for 
the general population. 

The list which follows shows the manner in which the great bulk 
of the deaths charged to this class were reported: dropsy, cardiac 
syncope, "dropped dead," sudden death, asthenia, atrophy, bilious- 
ness, cachexia, cardiac asthenia, cardiac failure, cardiac paralysis, 
catarrhal fever, collapse, coma, complication of diseases, congestion, 
debility, decline, disappearance, dyspnea, "fever," "found dead," 
gastric fever, general debility, general weakness, heart failure, in- 
fection, inflammation, inquest pending, malnutrition, natural 
causes, "operation," paralysis of heart, postoperative shock, pros- 
tration, shock, surgical operation, surgical shock, "undetermined," 
"unknown," unknown disease, unspecified, and weakness. 

It should be understood, moreover, that not all of the ill-defined 
diseases and conditions are classified here. The group simply 
covers the worst of the type. It will be well, in this connection, to 
read what is said about unsatisfactory reports of causes of death 
in the discussions on such subjects as meningitis, peritonitis, pneu- 
monia, etc. 

Five thousand four hundred and forty-eight (5,448) deaths of 
Industrial policyholders were charged to "ill-defined diseases" 
during the period 1911 to 1916; this corresponds to a death rate of 
10.1 per 100,000 exposed. 



SXJPPLEMElIiTT 



SUPPLEMENT. 
Mortality Statistics of Insured Wage Earners During 1917. 

It is possible at the present time to present a general statement 
on the mortality experience of the year 1917, although we can 
show only the facts for the combined experience without distinc- 
tion for the color, sex and age classes. The death rate in the aggre- 
gate during 1917 was 11.61 per 1,000 exposed. This is based upon 
a total of 125,955 deaths and an exposure of 10,847,852 years of 
life. The mortality experience of 1917 according to causes of 
death, classified under the titles of the detailed International List, 
is displayed in Table 176, page 294. 

The death rate from all diseases and conditions, combined, de- 
clined slightly in 1917 from the figure recorded for 1916 ; the rates 
being 11.61 and 11.68 per 1,000 persons exposed, respectively. 
The nine months of war in 1917 did not, therefore, result in any 
increase in the total mortality. Observation will show also that 
there were not many deaths of persons in military or naval service 
from causes incidental to military operations. Such deaths as oc- 
curred among the mobilized American forces were virtually limited 
to the acute infections in camps in the United States. 

Tuberculosis was the chief cause of death, being responsible for 
16.3 per cent, of all deaths in 1917. The death rate for all forms 
of tuberculosis was 188.9 per 100,000, and for tuberculosis of the 
lungs alone, including acute miliary tuberculosis, 172.3 per 100,- 
000 This was the lowest rate recorded for this disease in the 
mortality experience since 1911. In 1916, the rate was 172.8 per 
100,000. The difference between the rates for these two years, 
however, was the smallest of any between any two years in this 
experience, which indicates a slackening in the downward tendency 
of the mortality in recent years. 

Organic diseases of the heart followed tuberculosis in order of 
numerical importance. The rate was 142.0 per 100,000, which is 
higher than the rate for the six year period 1911 to 1916, 140.1. 
It was only in 1912 that the death rate reached a higher point, 
143.8. 

293 



294 



MOKTALITY STATISTICS OF INSUEED WAGE EAENERS. 






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SUPPLEMENT. 299 

The cancer death rate, and especially that for cancer of the 
breast, was nominally stationary during 1917. The slight in- 
crease from a rate of 70.3 per 100,000 in 1916 to 70.9 per 100,000 
in 1917 is of no practical significance. The average cancer death 
rate of the preceding six calendar years was 70.0 per 100,000. The 
1917 rate of 70.9 per 100,000 was reached also in another year of 
the preceding six, namely, in 1915. Among wage earners, there is 
no evidence that cancer is, or ever has been, progressively on the 
increase. The death rates for diabetes, suicide by asphyxia, sui- 
cide by hanging and accidental poisoning also remained practically 
stationary as compared with the figures for 1916. 

Significant Decreases in the Death Rates for Certain Causes of 
Death during 1917. 

The most significant fact in the 1917 experience from the stand- 
point of preventive medicine is the further substantial decline in 
the typhoid fever death rate. In 1917, 13.1 deaths from typhoid 
fever occurred per 100,000 persons exposed. This rate was not 
quite one-half that recorded in 1911 (22.8 per 100,000). The 
progressive decline in the death rate for this disease is ample evi- 
dence of the growing effectiveness of the American public health 
movement for the control of a disease which was once a scourge. 
A fact of importance in the present mortality experience is the 
continued decline of the death rate from malaria. In 1917 the 
rate was 2.3 per 100,000 persons exposed, the lowest since 1911, 
when 6.1 deaths from malaria were recorded for each 100,000 per- 
sons exposed. These encouraging facts for typhoid fever and ma- 
laria mortality are evidence also of the effectiveness of visiting 
nursing in the management of these diseases among policyholders. 
A large number of cases of both diseases are provided each year 
with visiting nurse care by the Company. In the southern states, 
especially in some of the local areas where nursing service is avail- 
able for policyholders, malaria and typhoid fever are of the first 
importance as causes of sickness. Among acute cases of malaria 
and among typhoid fever patients the practical bedside care given 
by the nurse and the accompanying instructions to the family in 
hygiene are really effective for life saving. Whooping cough mor- 
tality showed a decline from a rate of 5.8 per 100,000 in 1916 to 
a figure of 5.1 in 1917. This latter figure is not, however, the 



300 MORTALITY STATISTICS OF INSURED WAGE EARNERS. 

minimum recorded in these seven years of medical statistics of 
Industrial policyholders. In 1915 the whooping cough rate was 
4.7 per 100,000. 

The recorded mortality from influenza showed a decrease to a 
rate of 14.4 per 100,000. This may he compared with a figure of 
23.8 for 1916, which was the highest rate for the seven-year period, 
1911 to 1917. Acute poliomyelitis showed a tendency to return to 
its usually low rate. In 1917 there were recorded 1.6 deaths from 
this disease per 100,000 policyholders exposed. The rate which 
we may usually expect is approximately 1.2 per 100,000 persons 
exposed. 

Suicide mortality also declined during 1917, although slightly. 
The suicide death rate in that year was 9.3 per 100,000 persons 
exposed as compared with a rate of 9.8 in the preceding year, with 
an average rate of 12.2 per 100,000 for the six-year period, 1911 
to 1916. This phase of the suicide mortality experience of insured 
wage earners parallels that of the population in belligerent and 
neutral countries abroad. During war time, the suicide death rate 
of the civilian population usually shows a significant decrease. 
Deaths from accidental drowning showed a lower rate in 1917 (8.7 
per 100,000) than in 1916 (9.7 per 100,000). Deaths from fall- 
ing occurred at a rate of 11.9 per 100,000 in 1917 as compared 
with a figure of 13.1 per 100,000 in 1916. 

Significant Increases in the Death Bates for Certam Causes of 
Death during 1917. 

A small number of the more important causes of death showed 
significant increases during 1917. Both measles and scarlet fever 
had higher mortality rates than during 1916. Diphtheria also 
registered an increase of nearly four points per 100,000 over the 
rate for the year 1916. The 1917 diphtheria death rate was 
slightly in excess of the average for the preceding six years. 

The increase in the death rate from pellagra is a matter of some 
importance. The year 1916, it is true, showed a decrease as com- 
pared with 1915 and 1914; but in 1917 there followed a rise of 
about 14 per cent. It was remarked in the section given over 
to the discussion of pellagra in the preceding pages that the death 
rate for this disease in the South seems to follow the level of 
economic prosperity in the wage earning groups of the population 



SUPPLEMENT. 301 

of that section of the country. The increase in the pellagra death 
rate for the year 1917 is, perhaps, an indication that the nutri- 
tional conditions which influence the development of the disease in 
the first place, and aggravate its course in the second place, have 
returned, approximately, to the average of the preceding six years. 
During this period the pellagra death rate was 4.3 per 100,000 
persons exposed. The upward course of the pellagra death rate 
throughout 1917 may have been influenced by the single factor of 
high food prices brought about by war conditions. 

Mortality from pneumonia (lobar and undefined) showed an 
increase during 1917. In fact, the death rate for this disease (88.8 
per 100,000) was higher in 1917 than in any of the preceding six 
years of the present mortality experience except 1911. This rise 
in the pneumonia rate is perhaps best explained as the effect of 
severe weather conditions during the latter part of 1917. Mortal- 
ity from the diseases and conditions of the puerperal state like- 
wise showed an increase from a figure of 17.6 per 100,000 in 1916 
to a rate of 18.2 in 1917. The rate for the later year is, however, 
considerably under the average for the preceding six years (18.9 
per 100,000) and well under the maximum (20.0 per 100,000) 
observed for 1913. It will be recalled that the death rate for dis- 
eases and conditions of the puerperal state in 1916 was the lowest 
on record in the present study. The increase in the death rate 
for diseases and conditions associated with the maternal state may 
be accounted for largely by the increase in mortality from puer- 
peral septicemia. This fact of increased maternal mortality does 
not, in itself, indicate any increase in the fatality rate of the gra- 
vid and parturient state. The number of births must be taken into 
account. A further inquiry into the 1917 maternal mortality ex- 
perience, with this latter point in mind, is now being made. 

There was also a higher death rate from all forms of accidents, 
combined, during 1917 (76.5 per 100,000) than during 1916 
(73.2 per 100,000). The 1917 total accident rate is, however, 
well under the maximum for the period of seven years under ob- 
servation. This maximum rate was registered in 1913, a figure 
of 77.6 per 100,000 persons exposed. The increase in the total 
accident rate seems to have been due principally to increases in 
that for automobile accidents and injuries, from 7.4 per 100,000 in 
1916 to 9.7 per 100,000 in 1917. It will be recalled that the mini- 



302 MOETALITY STATISTICS OF INSURED WAGE EARNERS. 

mum rate for automobile accidents and injuries was 2.3 per 100,000 
in 1911 and the average for the six years, 1911 to 1916, 4.7 per 
1000,000. The automobile is gradually assuming the proportions 
of a serious menace to life, especially to the lives of children. 
Scarlet fever had a rate in 1917 two-thirds that ascribed to the 
automobile. 

Steam railroad accidents and injuries also showed an increase 
during 1917 over the figure for the preceding year. A death rate 
of 8.5 per 100,000 persons exposed was recorded in 1917 as com- 
pared with a figure of 7.9 per 100,000 in 1916. 



APPENDICES 



303 



ao4 



MORTALITY STATISTICS OF INSURED WAGE EARNERS. 



APPENDIX A. 

NuMBEB OF Deaths from Each Specified Disease or 
Metropolitan Life Insurance Company Industrial 





Cause of Deatb. 


Age Periods. 


Infl List 
Number. 


All 

ages — 1 

yr. and 

over. 


1 to 4. 


6 to 9. 


10 to 
14. 


15 to 
19. 


20 to 
24. 


1 to 189 


ALL CAUSES OF DEATH 
TOTAL 


635449 

252742 

267337 

53795 

61575 


58009 

27022 

24315 

3399 

3273 


26645 

12269 

10946 

1668 

1762 


16606 

6981 
6314 
1469 
1842 


26655 

10119 
9743 
2914 
3879 


35027 




12982 




White females 


13626 






3662 




Colored females 


4757 




I. General Diseases 

White males 




1 to 69 


225112 

86277 
93966 
20077 
24792 


22751 

10401 
9917 
1205 
1228 


13306 

5690 

5744 
894 
978 


7191 

2226 

2932 

739 

1294 


13673 

4096 
5319 
1672 
2586 


19124 
6567 




White females 


7492 




Colored males 


2115 




Colored females 


2950 




Typhoid fever 




1 


9011 

3380 
3297 
1088 
1246 

1 

1 

8 

1 
2 
2 
3 

2295 

451 
495 
542 
807 

103 

36 
36 
15 
16 


672 

231 

240 

45 

56 

1 
1 

293 

79 
77 
67 
70 

20 

7 

11 

1 

1 


936 

289 
379 
128 
140 

1 

1 

235 

73 
57 
51 
54 

9 

7 
2 


1065 

375 
390 
112 

188 

2 

1 

1 

123 

32 
31 
17 
43 

4 

1 

1 
2 


1495 

560 
544 
186 
205 

2 

1 

1 

117 

23 
19 
31 
44 

10 

6 
1 

■4 


1275 






529 




White females 


457 




Colored males . 


142 




Colored females 


147 


2 


Typhus fever 






White males 






White females 






Colored males 






Colored females 




3 


nelapsing fever 






White males 






White females 






Colored males 






Colored females 




4 


Malaria 


155 




White males 


26 




White females 


32 




Colored males 


42 




Colored females 


55 


5 


Smallpox 


8 




White males 


3 




White females 


3 






1 




Colored females 


1 









APPENDIX A. 



305 



APPENDIX A. 

Condition. Classified by C5oloEj Sex and by Age Pebiod. 
Mortality Experience, 1911 to 1916. 











Age Periods. 












25 to 
29. 


30 to 
34. 


35 to 
39. 


40 to 
44. 


45 to 
49. 


50 to 
54. 


55 to 
69. 


60 to 
64. 


65 to 
69. 


70 to 75 and 
74. over. 


Infl List 

Number. 


36105 

13075 

13918 

4180 

4932 


37324 

14121 

13507 

4558 

5138 


39907 

15390 

14346 

4965 

5206 


40245 

16236 

14674 

4637 

4698 


41139 

16773 

15764 

4129 

4473 


46595 

18567 

18929 

4355 

4744 


50108 

20038 

21595 

3972 

4503 


55565 

21746 

25353 

3843 

4623 


53419 

20441 

26298 

2960 

3720 


43942 

16752 

22580 

2081 

2529 


28158 

10230 

15429 

1003 

1496 


1 to 189 


18915 

6771 
7127 
2171 
2846 


18027 

7078 
6219 
2175 
2555 


17943 

7314 
6254 
2177 
2198 


16478 

6883 
6075 
1797 
1723 


14721 

6039 
5899 
1323 
1460 


14784 

5761 
6458 
1195 
1370 


14257 

5439 

6664 

980 

1174 


13049 

4781 

6465 

748 

1055 


10408 

3678 

5529 

473 

728 


6907 

2419 

3790 

282 

416 


3578 

1134 

2082 

131 

231 


1 to 59 


902 

348 

336 

91 

127 


664 

262 

205 

89 

108 

139 

21 
20 
42 
66 

4 

2 

1 
1 


518 

182 

180 

75 

81 

122 

19 
23 
29 
51 

10 

6 
2 
2 

1 


426 

159 

164 

57 

46 

1 


307 

113 

117 

41 

36 


294 

112 
94 
47 
41 

1 
1 

160 

27 
33 
36 
64 

8 

4 
2 
2 


209 

89 
66 
24 
30 

148 

16 
37 
37 
58 

6 

2 
3 

1 


168 

70 
56 
22 
20 

159 

25 
36 
32 
66 

6 

1 
3 
2 


110 

39 
38 
21 
12 

137 

24 
33 
32 

48 

1 

1 


48 

15 

20 

8 

5 

1 

1 

78 

15 
18 
17 
28 

2 

1 
1 


22 

7 
11 

4 

32 

7 

6 

9 

11 


1 
2 


145 

21 
26 
34 
64 

6 

1 
3 

1 


1 

114 

20 
19 

27 
48 

6 

2 
3 
1 


138 

23 
29 
39 
47 

4 

1 
2 

1 


3 
4 
5 



306 



MORTALITY STATISTICS OF INSURED WAGE EARNERS. 



Number of Deaths prom Each Specified Disease or 
Metropolitan Life Insurance Company Industrial 





Cause of Death. 


Age Periods. 


Int'l List 
Number. 


All 

ages — 1 

yr. and 

over. 


lto4. 


5 to 9. 


10 to 
14. 


15 to 
19. 


20 to 
24. 


6 


Measles 


4776 

2242 

2200 

160 

174 

4638 

2273 

2211 

75 

79 

3075 

1007 

1447 

281 

340 

13089 

6373 

6112 

292 

312 

8056 

2411 

3611 

810 

1224 

1 

1 

5 

2 
3 


3661 

1791 

1657 

107 

106 

2210 

1140 

1010 

25 

35 

2666 

895 

1261 

236 

274 

6868 

3519 

3089 

141 

119 

589 

268 

244 

45 

32 


793 

354 

374 

30 

35 

1635 

818 

770 

27 

20 

354 

100 

161 

39 

54 

4808 

2297 

2303 

98 

110 

252 

98 

113 

23 

18 

2 

1 
1 


112 

39 
55 

7 
11 

420 

176 

220 

16 

8 

28 

8 
8 
5 

7 

904 

379 

466 

26 

33 

158 

53 
65 
13 
27 


69 

28 

25 

9 

7 

171 

80 

80 

3 

8 

7 

1 
3 
1 
2 

182 

80 

84 

7 

11 

218 

74 
70 
29 
45 


32 




White males 


9 




White females 


17 




Colored males 


3 




Colored females 


3 


7 


Scarlet fever 


86 




White males 


27 




White females . ■ 


57 




Colored males 






Colored females 


2 


8 


Whooping cough 


1 




White males 


1 




White females 






Colored males 






Colored females 




9 


Diphtheria and croup 


86 




White males 


33 




White females 


40 




Colored males 


7 




Colored females 


6 


10 


Influenza 


254 




White males 


73 




White females 


91 




Colored males 


32 




Colored females 


58 


11 


Miliary fever 






White males 






White females 






Colored males 






Colored females 




12 


Asiatic cholera 






White males 






White females 






Colored males 






Colored females 











APPENDIX A. 



307 



Condition. Classified by Color, Sex and by Age Period. 
Mortality Experience, 1911 to 1916. 



Age Periods. 


























Infl List 


25 to 


30 to 


35 to 


40 to 


45 to 


so to 


55 to 


60 to 


65 to 


70 to 


75 and 


Number. 


29. 


34. 


39. 


44. 


49. 


54. 


69. 


64. 


69. 


74. 


over. 




28 


24 


16 


11 


9 


10 


4 


3 


2 


1 


1 


6 


4 


7 


2 


1 


2 


3 




1 






1 




18 


15 


12 


8 


6 


7 


2 


2 


2 








2 




1 








1 












4 


2 


1 


2 


1 




1 






1 






41 


29 


22 


8 


5 


3 


4 


3 






1 


7 


8 


8 


7 


4 


2 




2 


1 










30 


20 


12 


4 


1 


3 


1 


2 






1 




1 


1 


1 




1 
















2 




2 




1 




1 












2 


3 


2 


2 


2 

1 


2 


2 


2 
1 




2 




8 


' i 


3 


2 


2 


1 


2 


1 


1 




1 






1 












1 






1 






60 


60 


36 


23 


26 


13 


10 


9 


6 


6 


3 


9 


15 


10 


11 


9 


7 


2 


2 


3 


3 


2 


1 




34 


28 


18 


10 


13 


9 


7 


4 


3 


2 


2 




2 


.1 


2 
5 


3 


4 


2 


1 


2 




1 






9 


1 


2 




283 


288 


358 


344 


417 


603 


747 


902 


1042 


945 


656 


10 


67 


80 


109 


105 


124 


159 


226 


243 


290 


276 


166 




98 


96 


112 


126 


169 


254 


317 


423 


631 


609 


393 




48 


52 


68 


51 


49 


75 


82 


76 


78 


60 


29 




70 


60 


69 


62 


75 


115 


122 


160 


143 


100 


68 




1 






















11 


1 


1 
1 






1 
1 




1 

1 










12 



308 



MOETALITY STATISTICS OF INSURED WAGE EARNERS. 



Number of Deaths from Each Specified Disease oe 
Metropolitan Life Insurance Company Industrial 



Int'I List 
Number. 



Cause ol Death. 



Age Periods. 



All 

ages — 1 

yr. and 

over. 



10 to 
14. 



15 to 
19. 



13 



14 



15 



17 



18 



19 



Cholera nostras . 



White males. . . . 
White females . . 
Colored males . . 
Colored females. 



Dysentery. 



White males. . . . 
White females . . 
Colored males . . 
Colored females. 



Plague. 



White males. . . . 
White females . . 
Colored males . . 
Colored females. 



16 Yellow fever. 



White males. . . . 
White females . . 
Colored males . . 
Colored females. 



Leprosy . 



White males. . . . 
White females . . 
Colored males . . 
Colored females. 

Erysipelas 



White males. . . . 
White females . . 
Colored males . . 
Colored females. 



Other epidemic diseases . 



White males. .'. . 
White females . . 
Colored males . . 
Colored females. 



190 

83 
74 
13 
20 

2029 

648 
848 
212 
321 



1 
1 

11 

5 
2 
2 
2 

1289 

696 

573 

62 

58 

184 

86 

81 

7 

10 



32 

20 
9 

3 

626 

238 

226 

32 

30 



62 27 



21 



9 


18 


11 


18 


1 


2 




3 


13 


4 


2 


2 


8 


2 


3 





APPENDIX A. 



309 



Condition. Classified by Coloe, Sex and by Age Period. 
Mortality Experience, 1911 to 1916. 



Age Periods. 




25 to 
29. 


30 to 
34. 


35 to 
39. 


40 to 
44. 


45 to 
49. 


50 to 
54. 


55 to 
59. 


60 to 
64. 


65 to 
69. 


70 to 
74. 


75 and 
over. 


Inf 1 List 
Number. 


2 


5 


4 


8 


7 


17 


15 


23 


29 


15 


12 


la 


1 
1 


1 
2 


1 
2 

1 


3 
3 
2 


3 
3 

i 


4 

11 

1 

1 


7 
4 
3 
1 


11 

8 
1 
3 


13 

11 

2 

3 


6 

7 
1 
1 


2 
9 

1 




51 


52 


56 


61 


73 


122 


138 


206 


241 


200 


141 


14 


13 

13 

9 

16 


17 

14 

7 

14 

1 
1 


14 
11 
13 
18 


11 
13 

18 
19 


19 
33 

7 
14 


31 
45 
20 
26 


39 
52 
23 
24 


47 
88 
27 
44 


62 

115 

21 

43 


59 

109 

12 

20 

1 
1 


37 

74 

8 

22 

• • • 


15 
16 


1 


1 


1 


4 








1 


1 






17 


1 


i 


1 


2 

1 
1 








1 


1 








48 


73 


85 


98 


116 


122 


138 


143 


112 


101 


58 


18 


23 

19 

3 

3 


40 

23 

5 

5 


46 

32 

3 

4 


52 
38 

7 

1 


54 

49 

5 

8 


60 
52 

8 
2 


71 

58 

5 

4 


57 

68 

7 

11 


42 

59 

2 

9 


46 

44 
7 
4 


19 
37 

1 
1 






1 


2 


1 


3 


2 


4 


2 


4 


3 


2 


19 




1 


2 


1 


1 

1 

1 


2 


1 
3 


1 
1 


1 
3 


2 

1 


"2 





310 



MOETALITY STATISTICS OF INSURED WAGE EARNERS. 



Number of Deaths from Each Specified Disease or 
Metropolitan Life Insurance Company Industrial 





Cause of Death. 


Age Periods. 


Int'I List 
Number. 


All 

ages — 1 

yr. and 

over. 


1 to 4. 


5 to 9. 


10 to 
14. 


16 to 
19. 


20 to 
24. 


20 


Purulent infection and 

septicemia 


1083 

482 

427 

86 

88 

6 

3 
1 
2 

27 

21 
6 

84 

54 

17 

7 

6 

890 

479 

188 

166 

57 

14 

10 
2 

1 
1 

2310 

352 

1010 

194 

754 


84 

30 

48 
2 
4 

1 
1 

14 

9 
5 

40 

23 

14 

2 

1 

1 

1 

20 

4 

11 

3 

2 


74 

40 

30 

3 

1 

16 

11 

4 

1 

210 

128 

52 

24 

6 

1 

1 

24 

1 
8 
6 
9 


57 

27 

25 

4 

1 

19 

14 
2 
3 

154 

99 
16 
31 

8 

1 

1 

32 

4 

12 

7 

9 


61 

31 

20 

4 

6 

2 
2 

9 

7 
2 

71 

42 
8 

18 
3 

3 

2 
1 

67 

7 
25 

4 
21 


70 




White males 


37 




White females 


29 




Colored males 


1 




Colored females 


3 


21 


Glanders 






White males 






White females 






Colored males 






Colored females 




22 


Anthrax 


1 




White males 


1 




White females 






Colored males 






Colored females 




23 


Rabies 


2 




White males 


2 




White females 






Colored males 






Colored females 




24 


Tetanus 


47 




White males 


21 




White females 


9 




Colored males 


7 




Colored females 


10 


25 


Mycoses 






White males 






White females 






Colored males 






Colored females 




26 


Pellagra 


155 




White males 


7 




White females 


66 






7 




Colored females 


75 









APPENDIX A. 



311 



Condition. Classified by ColoBj Sex and by Age Period. 
Mortality Experience, 1911 to 1916. 



Age Periods. 



25 to 
29. 



30 to 
34. 



67 



3 
2 

1 

63 

29 

13 

16 

6 

1 

1 



207 

15 
93 
12 

87 



35 to 
39. 



48 

16 

11 
14 

7 



256 

25 
102 

16 
113 



40 to 
44. 



72 

26 
29 
10 

7 



3 
1 

1 

54 

27 

13 

11 

3 



278 

25 
130 

19 
104 



2 
1 

1 

45 

22 

12 

10 

1 

2 

1 

1 

280 

33 

135 

25 

87 



45 to 
49. 



68 

26 
21 
14 

7 



50 to 
54. 



83 

39 

25 

9 

10 



29 
12 



203 

24 
94 
21 
64 



55 to 
59. 



78 



4 

1 

1 
2 

34 

16 

7 
9 
2 

1 

1 



219 

38 

101 

26 

54! 



60 to 
64. 



87 

43 

32 

4 



39 

19 
6 

12 
2 

2 

2 



221 

57 
89 
19 
56 



65 to 
69. 



65 



2 
1 

1 
19 

9 

7 



177 

57 
74 
13 
33 



70 to 
74. 



21 

7 



114 



34 
46 



26 



75 and 
over. 



46 

21 

18 

2 

5 



12 



46 

14 

18 

5 

9 



26 



11 
13 



Infl Llat 
Number. 



20 



21 



21 



22 



23 



24 



25 



26 



312 



MORTALITY STATISTICS OF INSURED WAGE EARNERS. 



Number of Deaths from Each Specified D-isease or 
Metropolitan Life Insurance Company Industrial 





Cause of Death. 


Age Periods. 


Infl List 
Number. 


All 

agea — 1 

yr. and 

over. 


lto4. 


5 to 9. 


10 to 
14. 


15 to 
19 


20 to 
24. 


27 




4 

2 
1 

1 

110363 

45319 
37881 
13123 
14040 

93526 

39353 
31763 
10902 
11508 

6380 

2087 
2056 
1038 
1199 

4647 

1953 

1983 

357 

354 

3155 

791 

1179 

470 

715 

866 

381 


4095 

1669 

1583 

420 

423 

926 

277 
288 
171 
190 

263 

84 
89 
40 
50 

2324 

1038 

1017 

137 

132 

305 

131 

107 

44 

23 

■107 

50 


2742 

886 
963 
416 
477 

977 

202 
301 
220 
254 

202 

57 
65 
24 
56 

1008 

422 

426 

81 

79 

251 

73 
69 
52 
57 

140 

61 
51 
17 
11 


3053 

574 

1125 

461 

893 

1968 

258 
747 
307 
656 

257 

37 
86 
42 
92 

358 

135 

144 
32 

47 

213 

34 
66 
45 
68 

110 

51 
34 
11 
14 


10023 

2653 
3933 
1316 
2121 

8270 

2169 
3323 
1042 
1736 

867 

193 
315 
140 
219 

262 

96 

119 

31 

16 

324 

58 

92 

62 

112 

103 

48 
29 
14 
12 


















Colored males 






Colored females 




28 to 35 


Tuberculosis — all forms (total) 


15678 
5302 






6161 




Colored males 


1778 




Colored females 


2437 


28 


Tuberculosis of the lungs. . . 


13714 
4744 






5402 






1502 






2066 


29 


Acute miliary tuberciilosis. . 
White males 


1173 
321 




White females 


453 




Colored males 


164 




Colored females 


235 


30 


Tuberculous meningitis .... 
White males 


183 
59 




White females 


87 






22 




Colored females 


15 


31 


Abdominal tuberculosis. . . . 
White males 


348 
70 




White females 


136 




Colored males 


52 




Colored females 


90 


32 


Pott's disease 


75 




White males 


33 




White females 


3001 42 


19 




Colored males 


104 
81 


8 
7 


16 




Colored females 


7 









APPENDIX A. 



313 



Condition. Classified by Color, Sex and by Age Pekiod. 
Mortality Experience, 1911 to 1916. 











Age Periods. 










i 
























Int'l List 


25 to 


30 to 


35 to 


40 to 


45 to 


50 to 


55 to 


60 to 


65 to 


70 to 


75 and 


Number. 


29. 


34. 


39. 


44. 


49. 


54. 


59. 


64. 


69. 


74. 


over. 




2 






2 
















27 


1 
1 






1 

1 


















15309 


13844 


12466 


10043 


7303 


5554 


4260 


2992 


1742 


889 


370 


28 to 35 


5592 


5763 


5660 


5086 


3917 


3011 


2311 


1504 


870 


382 


139 




5739 


4583 


3873 


2892 


2034 


1535 


1243 


1011 


640 


385 


181 




1787 


1707 


1616 


1235 


813 


615 


444 


287 


133 


72 


23 




2191 


1791 


1317 


830 


539 


393 


262 


190 


99 


50 


27 




13719 


12511 


11286 


9140 


6704 


5093 


3868 


2690 


1554 


787 


319 


28 


5086 


5324 


5260 


4750 


3692 


2815 


2133 


1380 


795 


344 


124 




5192 


4142 


3479 


2613 


1816 


1386 


1119 


901 


564 


340 


150 




1547 


1497 


1414 


1072 


735 


548 


398 


250 


118 


59 


22 




1894 


1548 


1133 


705 


461 


344 


218 


159 


77 


44 


23 




960 


755 


657 


487 


290 


202 


121 


82 


37 


21 


6 


29 


300 


276 


255 


217 


126 


102 


57 


31 


18 


10 


3 




316 


221 


188 


116 


82 


43 


33 


29 


11 


7 


2 




156 


124 


126 


102 


44 


36 


20 


12 


5 


3 






188 


134 


88 


52 


38 


21 


11 


10 


3 


1 


1 




133 


85 


91 


64 


43 


28 


28 


20 


12 


5 


3 


30 


55 


33 


31 


28 


18 


11 


13 


9 


2 


2 


1 




51 


30 


35 


19 


14 


12 


8 


8 


8 


3 


2 




13 


11 


13 


8 


3 


2 


2 


1 


1 








14 


11 


12 


9 


8 


3 


5 


2 


1 








288 


278 


268 


223 


154 


135 


128 


105 


76 


37 


22 


31 


62 


53 


56 


48 


37 


44 


44 


36 


28 


11 


6 




107 


101 


116 


88 


75 


57 


52 


43 


35 


21 


14 




38 


44 


33 


36 


18 


15 


13 


14 


3 


1 






81 


80 


63 


51 


24 


19 


19 


12 


10 


4 


2 




65 


77 


46 


33 


29 


20 


18 


15 


13 


10 


5 


32 


25 


33 


19 


13 


11 


8 


12 


8 


4 


4 


1 




26 


30 


15 


14 


11 


11 


3 


6 


2 


4 


4 




10 


8 


6 


3 


3 


1 


2 




3 


2 






4 


' 


6 


3 


4 




1 


2 


4 









314 



MOETALITY STATISTICS OF INSURED "WAGE EARNERS. 



Number of Deaths from Each Specified Disease or 
Metropolitan Life Insurance Company Industrial 





Cause of Death. 


Age Periods. 


Inf iLlst 
Number. 


All 

ages — 1 
yr. and 
over" 


lto4. 


5 to 9. 


10 to 
14. 


15 to 
19. 


20 to 

24. 


33 


White swellings 


573 

278 

185 

77 

33 

959 

395 
329 
125 
110 

257 

81 
86 
50 
40 

174 

43 
57 
36 
38 

4659 

1984 
1004 

988 
683 

200 

46 
71 
31 
52 

37666 

10784 

22736 

946 

3200 


54 

31 

14 

4 

5 

96 

49 
25 
11 
11 

20 

9 
1 
5 
5 

132 

28 
38 
34 
32 

116 

43 
30 
20 
23 

5 

4 
1 

169 

78 

83 

4 

4 


73 

40 

26 

5 

2 

74 

30 

21 

9 

14 

17 

1 
4 
8 
4 

20 

9 
5 
2 
4 

45 

18 

12 

7 

8 

2 

1 

1 

109 

51 

52 

3 

3 


69 

30 

23 

11 

5 

63 

26 
18 
11 

8 

15 

3 
7 
2 
3 

4 

2 
1 

1 

41 

17 
9 

10 
5 

1 
1 

91 

46 

42 

1 

2 


65 

34 

20 

8 

3 

97 

48 

27 

9 

13 

35 

7 

8 

10 

10 

2 
2 

80 

19 

24 
13 
24 

25 

4 

10 

2 

9 

169 

75 

77 

7 

10 


45 




White males 


23 




White females 


14 




Colored males 


7 




Colored females 


1 


34 


Tuberculosis of other 

organs 


104 




White males 


40 




White females 


35 




Colored males 


11 




Colored females 


18 


35 


Disseminated tuberculosis. . 
White males 


36 
12 




White females 


15 




Colored males 


4 




Colored females 


5 


36 


Rickets 


1 




White males 






White females 


1 




Colored males 






Colored females 




37 


Syphilis 


181 




White males 


56 




White females 


42 




Colored males 


36 




Colored females 


47 


38 


Gonococcus infection 


28 




White males 


3 




White females 


13 




Colored males 


2 




Colored females 


10 


39 to 45 


Cancer and other malignant 
tumors — all forms (total).. . 

White males 


224 
99 




White females 


97 




Colored iriales 


4 




Colored females 


24 



APPENDIX A. 



315 



Condition. Classified by ColoRj Sex and by Age Period. 
Mortality Experience, 1911 to 1916. 



Age Periods. 


























Int'l List 


25 to 


30 to 


35 to 


40 to 


45 to 


50 to 


55 to 


60 to 


65 to 


70 to 


75 and 


Number. 


29. 


34. 


39. 


44. 


49. 


54. 


59. 


64. 


69. 


74. 


over. 




37 


38 


27 


25 


29 


34 


31 


13 


17 


11 


5 


33 


20 


15 


9 


9 


12 


15 


18 


9 


8 


4 


1 




5 


15 


11 


10 


11 


12 


7 


2 


8 


4 


3 




9 


5 


7 


3 


3 


7 


2 


2 




3 


1 




3 


3 




3 


3 




4 




1 








77 


76 


68 


57 


43 


35 


58 


55 


29 


17 


10 


34 


28 


24 


22 


18 


16 


13 


32 


27 


13 


6 


3 




33 


31 


22 


26 


20 


13 


17 


19 


10 


6 


6 




10 


12 


12 


9 


7 


4 


7 


6 


3 


4 






6 


9 


12 


4 




5 


2 


3 


3 


1 


1 




30 


24 


23 


14 


11 


7 


8 


12 


4 


1 




35 


16 


5 


8 


3 


5 


3 


2 


4 


2 


1 






9 


13 


7 


6 


5 


1 


4 


4 


2 








4 


6 


5 


2 




2 




2 










1 




3 


3 


1 


1 


2 


2 










1 


2 


3 






3 


2 


2 






2 


36 


1 


1 


1 






1 
2 


2 


2 






2 






1 
505 


2 












362 


706 


665 


583 


526 


367 


249 


133 


73 


27 


37 


115 


191 


325 


268 


276 


245 


171 


126 


67 


31 


16 




71 


100 


.137 


145 


121 


123 


76 


58 


33 


18 


5 




85 


131 


150 


154 


114 


104 


82 


42 


21 


15 


4 




91 


83 


94 


98 


72 


54 


38 


23 


12 


9 


2 




26 


26 


31 


17 


11 


15 


4 


3 


5 




1 


38 


4 


3 


6 


5 


2 


10 


3 


2 


3 








14 


9 


10 


5 


3 


1 






1 








3 


6 


5 


4 


2 


3 


1 


1 


1 








5 


8 


10 


3 


4 


1 










1 




422 


910 


1891 


2866 


3925 


5205 


5783 


5913 


4901 


3384 


1704 


39 to 45 


103 


156 


284 


478 


851 


1346 


1711 


2007 


1697 


1222 


580 




219 


537 


1205 


1915 


2514 


3247 


3488 


3369 


2882 


1977 


1032 




19 


27 


64 


86 


105 


155 


146 


159 


88 


50 


28 




81 


190 


338 


387 


455 


457 


438 


378 


234 


135 


64 





316 



MORTALITY STATISTICS OF INSURED WAGE EARNERS. 



NuMBBE OF Deaths from Each Specifiei> Disease ob 
Metropolitan Life Insurance Company Industrial 





Cause of Death. 


Age Periods. 


Infl Liat 
Number. 


AH 

agea — 1 
yr. and 
over. 


1 to 4 


5 to 9 


10 to 
14. 


15 to 
19. 


20 to 
24. 


39 


Of the buccal cavity 

White males 


1353 

989 

240 

75 

49 

14153 

5309 

7674 

494 

676 

4482 

1414 

2701 

103 

264 

7882 

6499 

1383 

3579 

31 

3004 

9 

535 

938 

478 

409 

25 

26 

5279 

2563 

2209 

240 

267 


6 

3 
2 

1 

20 

7 
13 

22 

14 
6 

2 

4 

4 

3 
3 

114 

51 

58 

4 

1 


4 
2 

11 

12 

9 
3 

5 
5 

5 

2 
3 

72 

31 

37 

2 

2 


5 

3 
2 

7 

2 
6 

13 

9 
3 
1 

3 

3 

1 
1 

5 

1 
4 

57 

31 
24 

2 


4 

2 

1 
1 

16 

6 

7 
2 

1 

18 

8 
8 
1 

1 

16 

14 
2 
1 

1 

2 

1 
1 

112 

58 

45 

3 

6 


12 
4 




White females 


Q 




Colored males 


1 




Colored females 


1 


40 


Of the stomach, liver 

White males 


35 
17 




White females .... 

Colored males 


10 
1 




Colored females 


7 


41 


Of the peritoneum, intes- 
tines, rectum 


42 




White males 


18 




White females 


21 




Colored males 


1 




Colored females 


2 


42 


Of the female genital organs 
White males 


30 




White females 


25 




Colored males 






Colored females 


5 


43 


Of the breast 


4 




White males 






White females 


3 




Colored males 






Colored females 


1 


44 


Of the skin 


4 




White males 


3 




White females 


1 




Colored males 






Colored females 




45 


Of other organs or of 

organs not specified . . . 

White males 


97 
57 




White females 


31 




Colored males 


1 




Colored females 


8 











APPENDIX A. 



317 



Condition. Classified by ColoRj Sex and by Age Period. 
Mortality Experience, 1911 to 1916. 











Age Periodf 


. 


































Int'l List 


25 to 


30 to 


35 to 


40 to 


45 to 


50 to 


55 to 


60 to 


65 to 


70 to 


75 and 


Number. 


29. 


34. 


39. 


44. 


49. 


64. 


59. 


64. 


69. 


74. 


over. 




4 


11 


30 


72 


117 


168 


218 


222 


229 


152 


99 


39 


2 


5 


20 


44 


86 


120 


157 


173 


180 


114 


74 




1 


4 


5 


18 


15 


25 


40 


29 


39 


30 


22 






1 


2 


6 


15 


12 


14 


11 


6 


3 


2 




1 


1 


3 


4 


1 


11 


7 


9 


4 


5 


1 




71 


186 


417 


745 


1184 


1907 


2436 


2716 


2183 


1522 


697 


40 


30 


56 


123 


236 


436 


715 


933 


1085 


837 


580 


239 




26 


84 


217 


416 


613 


1021 


1301 


1427 


1241 


868 


422 




7 


13 


29 


40 


53 


82 


84 


96 


45 


30 


12 




8 


33 


48 


53 


82 


89 


118 


108 


60 


44 


24 




73 


110 


213 


276 


393 


624 


643 


700 


653 


462 


228 


41 


22 


26 


52 


68 


119 


176 


210 


245 


217 


160 


61 




35 


57 


116 


161 


238 


385 


394 


424 


410 


284 


156 




5 


6 


10 


10 


7 


16 


12 


10 


10 


7 


7 




11 


21 


35 


37 


29 


47 


27 


21 


16 


11 


4 




143 


325 


727 


1022 


1212 


1277 


1169 


903 


598 


320 


128 


42 


95 


229 
96 


547 


816 


992 
220 


1078 
199 


988 
181 


785 
118 


523 
75 


283 
37 


112 
16 




48 


180 


206 




25 


108 


256 


412 


506 


553 


500 


416 


396 


256 


145 


43 






1 




3 


2 


2 


7 


9 


5 


2 




18 


86 


202 


346 


421 


470 


429 


342 


332 


223 


130 




2 




1 


2 


1 


2 






1 








5 


22 


52 


64 


81 


79 


69 


67 


54 


28 


13 




7 


9 


21 


27 


41 


67 


99 


154 


172 


180 


142 


44 


1 


5 


11 


15 


22 


39 


52 


83 


94 


80 


66 




5 


3 


6 


8 


14 


20 


39 


59 


74 


97 


75 




1 




1 


4 


3 


3 


4 


5 


1 


2 


1 






1 


3 




2 


5 


4 


7 


3 


1 






99 


161 


227 


312 


472 


609 


718 


802 


670 


492 


265 


45 


48 


64 


77 


115 


185 


294 


357 


414 


360 


283 


138 




39 


74 


112 


150 


221 


248 


297 


303 


263 


192 


115 




4 


7 


21 


24 


26 


40 


32 


37 


25 


8 


6 




8 


16 


17 


23 


40 


27 


32 


48 


22 


9 


6 





318 



MORTALITY STATISTICS OF INSURED WAGE EARNERS. 



Number of Deaths from Each Specified Disease or 
Metropolitan Life Insurance Company Industrial 





Cause of Death. 


Age Periods. 


Infl List 
Number. 


AH 

ages — 1 
yr. and 
over. 


lto4. 


6 to 9. 


10 to 
14. 


16 to 
19. 


20 to 
24. 


46 


Other tumors (tumors of the 
female genital organs 
excepted) 


293 

51 

161 

9 

72 

3409 

1303 

1511 

245 

350 

598 

159 

336 

41 

62 

21 

11 

8 

1 
1 

7762 

2305 

4754 

289 

414 

743 

40 

692 

8 

103 

164 

66 

103 

2 

3 


7 

4 
3 

126 

70 

48 
6 
2 

1 

1 

11 

7 
4 

83 

41 
39 

3 


3 

1 
2 

570 

266 
269 

17 
18 

3 

2 

1 

1 
1 

122 

53 
60 

7 
2 

1 

1 

1 

1 


2 

1 

1 

497 

202 

256 

16 

23 

4 

4 

1 

1 

224 

94 
121 

i 

8 

6 

1 
6 

2 

1 
1 


1 

1 

322 

150 

133 

15 

24 

9 

3 
6 

1 

1 
1 

242 

120 

109 

8 

5 

46 

7 
35 

4 

8 

4 
3 

1 


5 




White males 


I 




White females 


2 




Colored males 






Colored females 


2 


47 


Acute articular rheumatism .... 
White males 


209 
74 




White females 


98 




Colored males 


17 




Colored females 


20 


48 


Chronic rheumatism and gout. . 
White males 


10 
6 




White females 


2 




Colored males 


2 




Colored females 


1 


49 


Scurvy 


1 




White males 






White females 






Colored males 






Colored females 


1 


60 


Diabetes 


218 




White males 


109 




White females 


96 




Colored males 


10 




Colored females 


3 


51 


Exophthalmic goiter 


66 




White males 


8 




White females 


51 




Colored males 






Colored females 


7 


52 


Addison's disease 


14 




White males 


9 




White females 


5 




Colored males 




Colored females 









APPENDIX A. 



319 



Condition. Classified by Coix)Rj Sex and by Age Period. 
Mortality Experience, 1911 to 1916. 











Age 


Periods. 


































Int'l List 


25 to 


30 to 


35 to 


40 to 


45 to 


50 to 


55 to 


60 to 


65 to 


70 to 


75 and 


Number. 


29. 


34. 


39. 


44. 


49. 


54. 


59. 


64. 


69. 


74. 


over. 




14 


16 


27 


44 


28 


18 


27 


32 


32 


30 


7 


46 


3 


2 


1 


2 


4 


2 


4 


8 


7 


9 


1 




9 


6 


13 


15 


17 


13 


17 


17 


23 


18 


6 




1 


1 




3 


3 




1 












1 


7 


13 


24 


4 


"'3 


5 


"7 


2 


3 






166 


166 


147 


183 


170 


176 


192 


160 


168 


100 


57 


47 


53 


51 


48 


58 


57 


72 


60 


46 


48 


30 


18 




75 


70 


54 


66 


64 


59 


85 


81 


82 


49 


22 




13 


15 


24 


24 


18 


24 


17 


12 


13 


5 


9 




25 


30 


21 


35 


31 


21 


30 


21 


25 


16 


8 




16 


21 


15 


17 


44 


41 


64 


81 


108 


101 


63 


48 


7 


8 


4 


6 


10 


8 


18 


19 


26 


28 


11 




6 


9 


5 


9 


23 


28 


31 


43 


64 


64 


46 




1 


2 


2 


1 


4 


2 


6 


9 


4 


3 


4 




3 


2 


4 


1 


7 


3 


9 


10 


14 


6 


2 






1 




2 




1 


1 






1 




49 


. . . 


1 




1 




1 


1 






1 








1 






215 


239 


250 


333 


541 


859 


1191 


1257 


1066 


641 


281 


50 


95 


95 


90 


120 


150 


229 


291 


300 


261 


185 


72 




94 


106 


120 


158 


304 


525 


787 


867 


753 


426 


189 




11 


18 


22 


26 


34 


30 


49 


32 


18 


15 


8 




16 


20 


18 


29 


53 


75 


64 


58 


34 


15 


12 




68 


90 


86 


100 


80 


62 


49 


51 


27 


8 


3 


51 


4 


3 


2 


3 


5 


2 




3 


1 








54 


70 
2 


74 


80 

1 


62 
2 


48 


38 
3 


41 


25 


6 


'3 




io 


15 


10 


16 


11 


12 


8 


"7 


1 


2 






14 


14 


16 


14 


22 


16 


12 


11 


16 


3 


1 


52 


4 


4 


6 


5 


4 


1 


5 


5 


6 


2 






10 


10 


9 

1 


9 


16 
1 
1 


14 
1 


7 


6 


10 


1 


1 





320 



MORTALITY STATISTICS OF INSUKED WAGE EARNERS. 



Number of Deaths from Each Specified Disease or 
Metropolitan Life Insurance Company Industrial 





Cause of Death. 






Age Period* 






iDfl List 

Number. 


All 

ages — 1 

yr. and 

over. 


lto4. 


5 to 9. 

1 


10 to 
14. 


15 to 
19. 


20 to 
24. 


53 


Leukemia 


762 

378 

309 

39 

36 

1772 

507 

1103 

49 

113 

426 

160 

213 

18 

35 

2555 

1889 

405 

207 

54 

191 

168 

5 

18 

9 

6 

1 
2 

164 

69 

71 

8 

16 


70 

44 

22 

1 

3 

63 

29 

29 

5 

112 

58 

51 

2 

1 

3 

1 
1 
1 


88 

57 

27 

1 

3 

44 

27 
14 

3 

38 

17 
19 

2 

1 

1 
1 

1 


52 

30 

19 

3 

53 

13 

25 

1 

14 

22 

11 
10 

1 

2 
2 


58 

34 

14 

5 

5 

90 

30 

48 

2 

10 

35 

14 

16 

3 

3 

8 

2 

1 
2 
3 

2 

2 

6 
5 

1 


67 

36 

23 

4 




White males 




White females 




Colored males 




Colored females 


4 


54 


Anemia, chlorosis 


65 




White males 


9 




White females 


44 




Colored males 


3 




Colored females 


9 


65 


Other general diseases 


24 




White males 


8 




White females 


12 




Colored males 


2 




Colored females 


2 


66 


Alcoholism (acute or chronic) . . 
White males 


64 
37 




White females 


g 




Colored males 


6 




Colored females 


4 


67 


Chronic lead poisoning 

White males 


3 

s 




White females 






Colored males 






Colored females 




58 


Other chronic occupation 

poisonings 


1 




White males 






White females 


1 




Colored males 






Colored females 




69 


Other chronic poisonings 

White males 


17 
11 




White females 


3 




Colored males 






Colored females 


3 



APPENDIX A. 



321 



Condition. C1,assified by ColoRj Sex and by Age Period. 
Mortality Experience, 1911 to 1916. 



Age Periods. 



25 to 
29. 



30 to 
34. 



22 

5 

13 

2 

2 

208 

150 

36 

16 

6 

10 

7 
1 



35 to 
39. 



34 

14 

14 

3 

3 

78 

16 

54 

2 

6 

17 

5 

9 

1 
2 

315 

227 
61 
21 



18 



40 to 
44. 



5 

7 
2 
2 

454 

323 

70 
50 
11 

21 

19 
1 
1 



14 



105 123 



45 to 
49. 



50 to 
54. 



16 22 



11 
1 

4 
435 

317 

77 
33 



31 



41: 



49 
9ll 

i! 

10 



6 

14 

1' 

1 



1 


3 


1 


2 




1 


15 


14 


5 


4 


7 


9 


1 


1 


2 





57 



12] 20 

24 32 

2' 2 

3 3 

I 

15l! 193 



50 

124 

7 

12 



22 22 



345 295 



55 to 
59. 



26, 23 
20 23 

'61 ... 



15 



51 

26 

22 

2 

1 

232 



157 
5 
4 



198 



255 229 167 

59 40 17 

27l 18 12 

4' 8 2 



60 to 
64h 



14 

6 
6 
1 
1 



40 

23 

14 
1 

2 

193 

61 

126 

4 

2 

12 

4 
4 
1 
3 

114 

84 

18 

11 

1 

15 

14 

1 



70 to 
74. 



75 and 
over. 



32 



162 



49 



19 



11 



14 



11 8 

18 5 

1' 1 

2 .. . 



31 



13 4 

12 4 

1 

2 
1 
1 



10 



Infl List 
Niimber. 



63 



54 



65 



56 



67 



58 



59 



322 



MORTALITY STATISTICS OF INSURED WAGE EARNERS. 



Number of Deaths from Each Specified Disease or 
Metropolitan Life Insurance Company Industrial 





Cause of Deatb. 






Age Periods. 






Int'l List 
Number. 


All 

ages — 1 

yr.and 

over. 


1 to 4. 


5 to 9. 


10 to 
14. 


15 to 
19. 


20 to 
24. 


60 to 76 


II. Diseases of the Ner- 
vous System and of the 
Ohgans of Special 
Sense 


57606 

21801 

26150 

4184 

5471 


3961 

1950 

1645 

195 

171 


1865 

899 

766 

114 

86 


989 

435 

409 

79 

66 


1034 

480 
373 
104 

77 


919 




White males 


392 




White females 


326 




Colored males 


100 




Colored females 


101 




Encephalitis 




60 


519 

214 

200 

53 

52 

4171 

1907 

1663 

336 

265 

823 

378 

275 

97 

73 

797 

513 

191 

59 

34 

4049 

1846 

1716 

239 

248 

1889 

990 

768 

69 

62 


83 

37 

36 

4 

6 

1705 

834 

716 

82 

73 

279 

146 

112 

12 

9 

1149 

602 

473 

42 

32 

1095 

574 

453 

40 

28 


61 

27 

21 

7 

6 

799 

370 
327 

58 
44 

160 

70 
58 
19 
13 

2 

2 

555 

286 

228 

19 

22 

510 

265 

209 

16 

20 


38 

11 

18 

6 

3 

404 

164 

172 

35 

33 

101 

42 
33 
13 
13 

5 

4 
1 

133 

71 

53 

4 

5 

102 

53 

45 

1 

3 


40 

17 

20 

2 

1 

327 

165 

101 

40 

21 

90 

55 

17 

13 

5 

1 
1 

106 

58 

34 

5 

9 

55 

34 

17 

2 

2 


37 




White males 


20 




White females 


10 




Colored males 


2 




Colored females 


5 


61 


Meningitis (total) 


182 




White males 


71 




White females 


59 




Colored males 


30 




Colored females 


22 


*A61 


Cerebrospinal fever 

White males 


50 
18 




White females 


17 




Colored males 


g 




Colored females 


6 


62 


Locomotor ataxia 


3 




White males 


1 




White females .■ 


1 




Colored males 


1 




Colored females 




63 


Other diseases of the spinal 
cord (total) 


83 




White males 


35 




White females 


36 




Colored males 


8 




Colored females . 


4 


A63 


Acute anterior poliomyelitis 
White males 


27 
11 




White females 


13 




Colored males 


3 




Colored females 





* Includes only deaths reported as due to cerebrospinal fever during the 



APPENDIX A. 



323 



Condition. Classified by ColoRj Sex and by Age Period. 
Mortality Experience, 1911 to 1916. 











Age Periods. 


































Int'l Llat 


25 to 


30 to 


35 to 


40 to 


45 to 


so to 


55 to 


60 to 


65 to 


70 to 


75 and 


Number. 


29. 


34. 


39. 


44. 


49. 


54. 


59. 


64. 


69. 


74. 


over. 




1013 


1400 


1831 


2569 


3522 


5090 


6173 


7716 


8052 


6895 


4577 


60 to 76 


392 


554 


653 


898 


1149 


1701 


2215 


2821 


2955 


2614 


1693 




395 


490 


676 


996 


1515 


2168 


2757 


3612 


3991 


3537 


2494 




118 


181 


236 


302 


361 


513 


488 


515 


437 


286 


155 




108 


175 


266 


373 


497 


708 


713 


768 


669 


458 


235 




40 


26 


22 


31 


27 


31 


29 


19 


17 


9 


9 


60 


19 


12 


5 


17 


6 


15 


8 


5 


6 


4 


5 




13 


2 


9 


9 


14 


12 


13 


10 


6 


4 


3 




4 


7 


1 


1 


4 


2 


6 


3 


3 


1 






4 


5 


7 


4 


3 


2 


2 


1 


2 




1 




135 


126 


90 


100 


85 


75 


44 


52 


25 


14 


8 


61 


59 


40 


34 


41 


36 


31 


21 


23 


7 


8 


3 




60 


52 


28 


41 


30 


28 


16 


20 


16 


4 


3 




18 


17 


15 


14 


9 


8 


3 


4 


1 


1 


1 




8 


17 


13 


4 


10 


8 


4 


5 


1 


1 


1 




33 


26 


19 


19 


17 


15 


3 


6 


4 


1 




61 


12 


7 
5 


7 
4 


5 


6 


5 

1 


1 


3 
1 


4 


1 






12 


7 


4 




5 


9 


2 


5 


3 


6 


1 












4 


5 


6 


2 


4 


3 


1 


2 










9 


23 


47 


86 


90 


126 


149 


116 


68 


46 


26 


62 


4 


13 


25 


55 


58 


84 


94 


79 


42 


32 


20 




3 


7 


15 


20 


18 


27 


38 


25 


19 


13 


4 




1 


1 


3 


8 


8 


10 


10 


7 


6 


1 


2 




1 


2 


4 


3 


6 


5 


7 


5 


1 








64 


90 


87 


122 


143 


248 


234 


320 


339 


244 


132 


63 


25 


36 


37 


37 


53 


83 


85 


129 


148 


107 


54 




28 


36 


38 


52 


61 


106 


110 


148 


146 


105 


62 




5 


11 


8 


18 


11 


26 


21 


14 


26 


15 


6 




6 


7 


4 


15 


18 


33 


18 


29 


19 


17 


10 




9 


16 


4 


7 


7 


7 


12 


11 


17 


5 


5 


A63 


5 


8 


3 


5 


1 


6 


7 


3 


11 


3 


1 




3 


4 


1 




2 


1 


4 


5 


6 


1 


4 




1 


1 
3 




2 


4 




1 


3 




1 







period 1912 to 1916; such deaths were not tabulated separately in 1911. 



824 



MORTALITY STATISTICS OF INSURED WAGE EARNERS. 



NuMBEE OF Deaths from Each Specified Disease ok 
Metropolitan Life Insurance Company Industrial 





Cause ol Death. 


Age Periods. 


Inf 1 List 
Number. 


All 

ages — 1 

jT. and 

over. 


lto4. 


5 to 9. 


10 to 
14. 


15 to 
19. 


20 to 
24. 


64 


Cerebral hemorrhage, apoplexy 


36638 

12886 

17855 

2347 

3550 

488 

193 

215 

38 

42 

2773 

758 

1066 

358 

591 

2224 

1056 
691 
274 
203 

757 

195 

389 

82 

91 

1869 

864 
689 
181 
135 

98 

28 

49 

6 

15 


138 

54 
60 
12 
12 

1 

1 

19 

11 

7 
1 

2 
2 

59 

26 

26 

4 

3 


54 

23 

20 

9 

2 

3 
2 

1 

17 

9 
5 
3 

1 
1 

76 

38 

33 

2 

3 

30 

14 
13 

1 
2 


51 

25 

14 
5 

7 

4 

3 
1 

19 

5 
8 
4 
2 

2 
"2 

116 

59 

40 

12 

5 

11 

7 
1 
1 
2 


96 

31 

39 

9 

17 

8 

4 
2 
1 
1 

18 

7 
6 
2 
3 

7 

4 
2 

1 

28 

6 

14 

4 

4 

215 

99 
75 
28 
13 

9 

"7 
1 
1 


160 

55 






69 




Colored males 


18 




Colored females 


28 


65 


Softening of the brain 


5 




White males 


1 






3 




Colored males 






Colored females 


1 


66 


Paralysis without specified 

cause 


12 




White males 


1 




White females 


2 




Colored males 


6 




Colored females 


3 


67 


General paralysis of the insane. 
White males 


4 
2 




White females 


1 




Colored males 


1 




Colored females 




68 


Other forms of mental 

alienation 


51 




White males 


16 




White females 


21 




Colored males 


7 




Colored females 


7 


69 


Epilepsy 


220 




White males 


108 




White females 


72 




Colored males 


20 




Colored females 


20 


70 


Convulsions (nonpuerperal) . . . 
White males 


8 
1 




White females 


7 




Colored males 






Colored females 











APPENDIX A. 



325 



Condition. Classified by ColoRj Sex and by Age Period. 
Mortality Experience, 1911 to 1916. 



Age Periods. 



25 to 

29. 



30 to 
34. 



35 to 
39. 



40 to 

44. 



45 to 
49. 



50 to 
54. 



55 to 
59. 



60 to 
64. 



70 to 

74. 



75 and 
over. 



lat'l Llat 
Number. 



248 

80 
80 
47 
41 



62 

17 

32 

6 

7 

229 

104 
92 
20 
13 

10 



506 

176 

185 

69 

76 



133 

69 
33 
20 
11 



21 

31 

8 

15 

188 

96 

58 

27 

7 

10 

1 
4 
1 
4 



861 

263 
334 
109 
155 

10 

5 
2 
2 
1 



56 

16 
11 
15 
14 

249 

133 
52 

47 
17 



75 68 



18 

32 

9 

9 

162 

55 
75 
14 
18 



1378 

410 
555 
165 

248 

17 



104 

26 
26 
23 
29 

300 

152 
78 
37 
33 



86 

15 

54 

7 

10 

159 

75 
57 
12 
15 

3 
3 



2308 

668 

1067 

230 

343 

23 



12 
3 

172 

27 
68 
18 
59 

311 

164 
78 
49 
20 

74 

21 

34 

8 

11 

104 

48 

39 

9 



3698 

1173 

1676 

340 

509 

30 

7 

14 

5 

4 



260 

43 

72 
58 
87 

277 

144 
73 
31 
29 



78 

19 

43 

10 

6 

71 

34 

24 

9 

4 



4805 

1688 

2245 

332 

540 

35 

12 

17 

2 

4 



325 

90 

101 

50 

84 

234 

103 
76 
34 
21 



63 



6172 

2252 

2988 

373 

559 

71 

24 

33 

9 

5 



441 

112 

172 

54 

103 



6575 

2410 

3363 

306 

496 



95 
79 
20 
24 



74 

21 

36 

9! 



69 

24i 
29 i 

'I 



5753 

2160 

3049 

206 

338 



101 100 



525 

160 

221 
50, 

94; 



69 
79 
19 

18 



48 

19 

22 

3 

4 

51 

31 

14 

2 

4 

1 



426 

137 

186 
39 
64 



218 185 163 



3835 

1418 

2121 

117 

179 



300 

90 

158 

19 

33 

103 

43 

53 

4 

3 



31 

8 

19 

3 

1 

35 

20 
8 
2 
5 



17 



3 

12 



25 

12 

11 

1 

1 



64 



65 



66 



67 



68 



69 



70 



326 



MOKTALITY STATISTICS OF INSURED WAGE EAENERS. 



Number of Deaths from Each Specified Disease or 
Metropolitan Life Insurance Company Industrial 





Cause of Death. 


Age Periods. 


Inf 1 List 
Number. 


All 

ages — 1 

yr. and 

over. 


ito4. 


5to9. 


10 to 
14. 


15 to 
19. 


20 to 
24. 


71 


Convulsions of infants 

White males 


461 

204 

186 

34 

37 

98 

26 

65 

3 

4 

310 

102 

164 

15 

29 

1349 

632 
592 
108 
117 

43 

16 

18 
2 

7 

962 

461 

401 

49 

51 

94415 

34636 

43556 

7257 

8966 


458 

204 

184 

34 

36 

6 

4 
1 

1 

2 

1 
1 

88 

50 

32 

6 

14 

8 
6 

237 

118 

101 

9 

9 

563 

265 

229 

35 

34 


3 

2 

1 
11 

4 

7 

1 
1 

92 

46 
37 

7 
2 

6 

3 
2 

1 

154 

74 

70 

7 

3 

1583 

657 

810 

49 

67 


21 

6 
16 

3 

2 
1 

73 

39 

25 

6 

3 

1 

1 

108 

39 

57 

6 

6 

2096 

808 

1098 

81 

109 


18 

2 
14 

1 
1 

2 

1 
1 

67 

33 

25 

5 

4 

3 

1 
2 

89 

63 

31 

3 

2 

2201 

923 

1011 

115 

152 






White females 






Colored males 






Colored females 




72 


Chorea 


9 




White males 


2 




White females 


7 




Colored males 






Colored females 




73 


Neuralgia and neuritis 

White males 


9 
1 




White females 


5 




Colored males 


1 




Colored females 


2 


74 


Other diseases of the nervous 
system 


78 




White males 


38 




White females 


29 




Colored males 


4 




Colored females 


7 


75 


Diseases of the eyes and their 
annexa 






White males 






White females 






Colored males 






Colored females 




76 


Diseases of the ears 


58 




White males 


40 




White females 


14 




Colored males 


2 




Colored females 


2 


77 to 85 


III. Diseases of the 

ClRCULATOKY SySTEM . 

White males 


2060 

757 




White females 


964 




Colored males 


125 




Colored females 


214 



APPENDIX A. 



327 



Condition. Classified by Coloe^ Sex and bt Age Period. 
Mortality Experience, 1911 to 1916, 











Age 


Periods. 


































Infl List 


25 to 


30 to 


35 to 


40 to 


45 to 


50 to 


55 to 


60 to 


65 to 


70 to 


75 and 


Number. 


29. 


34. 


39. 


44. 


49. 


54. 


59. 


64. 


69. 


74. 


over. 


























71 


7 


1 


2 




1 


2 


3 


7 


1 


6 


3 


72 


2 


1 










3 


3 










6 




1 

1 




1 


2 




4 


i 


6 
1 


3 




23 


32 


36 


29 


31 


33 


34 


26 


21 


12 


16 


73 


8 


12 


11 


10 


9 


10 


13 


7 


8 


5 


6 




13 


15 


19 


17 


19 


18 


16 


12 


9 


7 


10 








2 




1 


2 


4 


3 






1 




2 


5 


4 


2 


2 


3 


1 


4 


4 








71 


95 


111 


122 


115 


107 


90 


101 


71 


44 


24 


74 


29 


33 


38 


40 


32 


41 


40 


39 


12 


16 


6 




32 


39 


50 


62 


63 


51 


35 


39 


38 


19 


16 




6 


6 


8 


13 


10 


7 


7 


8 


11 


3 


1 




4 


17 


15 


7 


10 


8 


8 


15 


10 


6 


1 










1 


1 


1 


2 


6 


4 


2 


2 


75 


. ... 






1 


1 




1 


1 
4 


1 
2 


1 


1 














1 


1 


1 


1 


1 


1 




47 


35 


27 


31 


32 


52 


34 


22 


20 


10 


6 


76 


26 


21 


12 


11 


17 


17 


11 


7 


8 


6 


1 




16 


11 


9 


15 


8 


23 


16 


12 


10 


4 


4 




4 


2 


2 


2 


3 


5 


3 








1 




1 


1 


4 


3 


4 


7 


4 


3 


2 








2457 


3170 


4260 


6129 


6331 


8134 


9782 


12811 


13687 


12132 


8019 


77 to 85 


835 


1047 


1316 


1654 


2188 


2791 


3628 


4811 


5264 


4687 


3005 




1072 


1212 


1597 


1944 


2459 


3431 


4294 


5995 


6793 


6255 


4392 




257 


440 


616 


707 


737 


853 


850 


897 


709 


638 


248 




293 


471 


731 


824 


947 


1059 


1010 


1108 


921 


652 


374 





328 



MORTALITY STATISTICS OF INSURED WAGE EARNERS. 



NuMBEjR OF Deaths from Each Specified Disease or 
Metropolitan Life Insurance Company Industrial 





Cauae of Death. 


Age Periods. 


Int'l List 
Niimber. 


All 

ages — 1 

jrr. and 

over. 


1 to 4. 


5 to 9. 


10 to 
14. 


15 to 
19. 


20 to 
24. 


77 


Pericarditis 


624 

197 

252 

73 

102 

5080 

1871 

2269 

412 

528 

75345 

26923 

35225 

5830 

7367 

2218 

977 
889 
141 
211 

9142 

4020 

3894 

651 

577 

1192 

380 

628 

84 

100 

455 

118 

267 

24 

46 


11 

2 

7 
2 

150 

75 

63 

6 

6 

328 

150 

133 

• 22 

23 

2 
2 

10 

6 
3 

1 

2 

1 
1 


42 

15 

22 

2 

3 

302 

110 

169 

8 

15 

1182 

503 

600 

35 

44 

8 

5 

2 

1 

1 
1 

12 

5 

7 

4 

3 
1 


31 

10 

17 

2 

2 

271 

98 

149 

10 

14 

1754 

683 

917 

63 

91 

5 

1 
3 

"l 

4 
3 
1 

9 

4 
4 

1 

1 
1 


23 

12 

7 
3 
1 

280 

110 

133 

13 

24 

1833 

774 

848 

92 

119 

14 

6 
4 
2 
2 

12 

6 
3 

1 
2 

17 

6 
9 

1 
1 

5 

2 

2 

1 


25 




White males 


9 




White females 


9 




Colored males 






Colored females 


7 


78 


Acute endocarditis 


268 




White males 


96 




White females 


124 




Colored males 


19 




Colored females 


29 


79 


Organic diseases of the heart . . . 
White males 


1667 
620 




White females 


787 




Colored males 


98 




Colored females 


162 


80 


Angina pectoris 


25 




White males 


7 




White females 


12 




Colored males 


4 




Colored females 


2 


81 


Diseases of the arteries, 

atheroma, aneurism, etc. . . . 

White males 


15 
7 




White females 


2 




Colored males 


2 




Colored females 


4 


82 


Embolism and thrombosis 

White males 


34 
8 




White females 


22 




Colored males 






Colored females 


4 


83 


Diseases of the veins (varices, 
hemorrhoids, phlebitis, etc.) 

White males 


9 
2 




White females 


4 




Colored males 


1 




Colored females 


2 



APPENDIX A. 



329 



Condition. Classified by Color, Sex and by Age Period. 
Mortality Experience, 1911 to 1916. 



Age Periods. 


























Infl List 


25 to 


30 to 


35 to 


40 to 


45 to 


50 to 


55 to 


60 to 


65 to 


70 to 


75 and 


Number. 


29. 


34. 


39. 


44. 


49. 


54. 


59. 


64. 


69. 


74. 


over. 




37 


36 


42 


35 


45 


49 


63 


62 


47 


53 


23 


77 


8 


10 


10 


15 


13 


20 


18 


20 


18 


14 


■i 




18 


6 


9 


8 


18 


15 


22 


27 


20 


30 


17 




6 


10 


11 


4 


6 


5 


9 


6 


4 


3 






5 


10 


12 


8 


8 


9 


14 


9 


5 


6 


3 




293 


352 


443 


431 


580 


645 


714 


178 


81 


67 


25 


78 


90 


137 


139 


143 


230 


244 


282 


65 


24 


19 


9 




135 


138 


185 


173 


215 


278 


322 


89 


43 


38 


15 




29 


28 


65 


55 


58 


51 


51 


10 


4 


4 


1 




39 


49 


54 


60 


77 


72 


59 


14 


10 


6 






1970 


2561 


3403 


4202 


5089 


6571 


7790 


10702 


11055 


9390 


5848 


79 


696 


824 


1035 


1354 


1711 


2161 


2794 


3898 


4083 


3499 


2138 




860 


1008 


1309 


1602 


2018 


2838 


3450 


5085 


5622 


4919 


3229 




191 


359 


447 


559 


578 


699 


705 


770 


588 


431 


193 




223 


370 


612 


687 


782 


873 


841 


949 


762 


541 


288 




39 


65 


95 


120 


166 


216 


286 


368 


386 


277 


146 


80 


7 


27 


37 


33 


72 


107 


145 


157 


189 


132 


52 




19 


16 


26 


42 


45 


67 


110 


162 


163 


128 


88 




7 


5 


18 


20 


16 


15 


16 


19 


12 


6 






6 


17 


14 


25 


33 


27 


15 


30 


22 


11 


6 




45 


88 


170 


195 


271 


463 


751 


1267 


1873 


2136 


1851 


81 


15 


26 


60 


72 


115 


199 


332 


584 


882 


951 


768 




10 


14 


18 


36 


68 


141 


295 


520 


803 


1022 


961 




14 


30 


67 


62 


58 


61 


57 


76 


88 


84 


50 




6 


18 


25 


25 


30 


62 


67 


87 


100 


79 


72 




41 


38 


52 


83 


113 


118 


110 


143 


168 


154 


90 


82 


10 


13 


21 


19 


32 


35 


40 


57 


46 


50 


28 




19 


15 


25 


49 


55 


58 


55 


66 


94 


91 


56 




3 


4 


3 


2 


16 


14 


7 


9 


12 


9 


3 




9 


6 


3 


13 


10 


11 


8 


11 


16 


4 


3 




14 


18 


42 


40 


50 


50 


49 


66 


53 


29 


23 


83 


4 


5 


9 


7 


10 


18 


13 


19 


14 


7 


4 




7 


11 


21 


27 


33 


27 


31 


33 


33 


19 


17 




2 


1 


2 


1 


3 


3 


2 


6 


1 




1 




1 


1 


10 


5 


4 


2 


3 


8 


6 


3 


1 





330 



MORTALITY STATISTICS OF INSURED WAGE EARNERS. 



Number of Deaths from Each Specified Disease or 
Metropolitan Life Insurance Company Industrial 





Cause of Death. 


Age Periods. 


Infl List 
Number. 


All 

ages — 1 
yr. and 
over. 


1 to 4. 


5 to 9. 


10 to 
14. 


15 to 
19. 


20 to 
24. 


84 


Diseases of the lymphatic sys- 
tem (lymphangitis, etc.) . . . 


165 

83 
56 
15 
11 

194 

67 

76 
27 
24 

71345 

29140 

29443 

6642 

6120 


57 

32 

17 

5 

3 

3 

3 

13887 

6208 
5611 
1026 
1042 


27 

14 
7 
2 
4 

5 

2 
1 
1 
1 

2888 

1218 

1195 

206 

269 


14 

6 
5 
3 

7 

2 
3 
1 
1 

1168 

435 
478 
121 
134 


6 

2 
2 

1 
1 

11 

6 
3 

1 
2 

1786 

697 
563 

248 

278 


8 
3 






3 




Colored males 


1 




Colored females 


1 


85 


Hemorrhage; other diseases of 
the circulatory system 


9 
6 






1 




Colored males 








3 


86 to 98 


IV. Diseases of the Re- 
spiratory System .... 


2200 
812 




White females 


666 






377 






345 




Diseases of the nasal fossae . . . 




86 


72 

33 

26 

9 

4 

594 

305 

227 

34 

28 

188 

26 

130 

5 

27 

2636 

943 

1224 

196 

273 


12 

7 
2 
3 

300 

167 

111 

9 

13 

4 

2 
2 

1218 

500 

494 

98 

126 


6 

5 

1 

119 

64 

51 

4 

5 

2 
3 

143 

64 

57 

6 

16 


7 

4 
3 

24 

12 

10 

2 

13 

5 

7 

1 

35 

14 
6 

7 
8 


5 

3 

2 

7 

3 

2 
1 
1 

15 

5 
5 
1 
4 

37 

8 
12 

3 
14 


2 




White females 


1 




Colored males 


1 




Colored females 




87 




8 






3 






2 






2 






1 


88 


Diseases of the thyroid body. . . 
White males 


16 
3 






12 






1 








89 




35 






9 




White females 


10 






8 




Colored females 


8 



APPENDIX A. 



331 



Condition. Classified by ColoRj Sex and by Age Period. 
Mortality Experience, 1911 to 1916. 











Age PerlodE 


. 


































Infl List 


25 to 


30 to 


35 to 


40 to 


45 to 


50 to 


55 to 


60 to 


65 to 


70 to 


75 and 


Number. 


29. 


34. 


39 


44. 


49. 


54. 


59. 


64. 


69. 


74. 


over. 




7 


4 


5 


6 


2 


4 


6 


6 


5 


6 


2 


84 


4 


1 


3 


5 




2 


1 


5 


3 


2 






1 


2 


2 


1 


2 


1 


4 


1 


2 


4 


"2 




1 


1 








1 














1 












1 












11 


8 


8 


17 


15 


18 


13 


19 


19 


20 


11 


85 


1 


4 


2 


6 


6 


5 


3 


6 


5 


13 


3 




3 


2 


2 


6 


5 


6 


5 


12 


13 


4 


7 


- 


4 


2 


3 


4 


2 


4 


3 


1 




1 






3 




1 


1 


3 


3 


2 




1 


2 


1 




2572 


3048 


3484 


3876 


4111 


4883 


5550 


6285 


6358 


5524 


3725 


86 to 98 


991 


1297 


1513 


1742 


1879 


2140 


2302 


2468 


2333 


1929 


1176 




781 


855 


989 


1212 


1344 


1814 


2362 


2928 


3334 


3065 


2246 




480 


515 


586 


557 


533 


519 


413 


440 


288 


217 


116 




320 


381 


396 


365 


355 


410 


473 


449 


403 


313 


187 




3 


1 


3 


1 


6 


2 


1 




9 


7 


7 


86 


3 






1 


2 








3 


3 


2 








1 




2 


1 


1 




4 


3 


5 








2 




1 


1 








1 








i 






1 








2 








16 


17 


14 


14 


13 


10 


11 


7 


19 


9 


6 


87 


3 


4 


8 


6 


6 


2 


6 


6 


9 


5 


1 




4 


11 


4 


3 


2 


3 


5 


1 


10 


4 


4 




5 


2 


2 


3 


2 


2 














4 






2 


3 


3 










1 




10 


12 


13 


12 


15 


15 


21 


12 


13 


8 


4 


88 


1 


1 


1 




2 


1 




2 


1 








9 


7 
2 


10 


11 


8 


11 


16 

1 


9 


9 


"l 


4 






2 


2 


1 


5 


3 


4 


1 


3 


1 






42 


39 


49 


44 


49 


59 


103 


146 


197 


231 


209 


89 


10 


10 


15 


11 


24 


21 


30 


54 


59 


66 


48 




10 


7 


14 


13 


11 


29 


62 


79 


124 


149 


147 




13 


8 


9 


10 


10 


3 


6 


5 


3 


2 


5 




9 


14 


11 


10 


4 


6 


5 


8 


11 


14 


9 





332 



MORTALITY STATISTICS OF INSURED WAGE EARNERS. 



Number of Deaths from Each Sphkjipted Disease or 
Metropolitan Life Insurance Company Industrial 





Cauae of Death. 


Age Periods. 


Int'l List 
Number. 


All 

ages — 1 

yr. and 

over. 


lto4. 


5 to 9. 


10 to 
14. 


15 to 
19. 


20 to 
24. 


90 


Chronic bronchitis 


4224 

1453 

2070 

286 

415 

16224 

6338 
7505 
1152 
1229 

41707 

17659 

16185 

4318 

3545 

1985 

853 
740 
213 
179 

939 

319 

456 

85 
79 

171 

100 
53 
11 

7 

1594 

607 
583 
182 
222 


75 

29 
24 
10 
12 

7007 

3096 

2896 

514 

501 

4874 

2203 

1930 

375 

366 

246 

145 

86 

12 

3 

95 

35 

48 
4 

8 

3 

1 
2 

36 

19 

8 
1 
8 


63 

22 

25 

6 

10 

972 

387 
426 

77 
82 

1430 

605 
575 
101 
149 

92 

41 
39 

7 
5 

21 

10 
7 
2 
2 

3 

2 

1 

15 

7 
3 
2 
3 


30 

5 

12 

7 

6 

220 

82 
90 
19 
29 

754 

286 
316 

72 
80 

54 

18 

22 

8 

6 

10 

4 
2 

2 
2 

4 

2 
1 

1 

4 

2 

1 

1 


57 

9 
14 

9 
25 

222 

69 
79 
39 
35 

1263 

524 

398 
164 
177 

112 

46 
38 
17 
11 

17 

6 
6 
3 
2 

8 

3 

1 
2 
2 

9 

6 

1 
2 


92 




White males 


24 




White females 


16 




Colored males , 

Colored females 


16 
36 


91 


Bronchopneumonia 


216 




White males 


60 




White females 


86 




Colored males 


31 




Colored females 


39 


92 


Pneumonia — lobar and 
iindefinpid , 


1608 




White males 


630 




White females 


463 




Colored males 


286 




Colored females 


229 


93 


Pleurisy 


128 




White males 


53 




White females 


41 




Colored males 


20 




Colored females 


14 


94 


Pulmonary congestion, pul- 
monary apoplexy 


21 




White males 


7 




White females 


6 




Colored males 


3 




Colored females 


5 


95 


Gangrene of the lung 


11 




White males 


3 




White females 


6 




Colored males 


2 




Colored females 




96 


Asthma 


13 




White males 


2 




White females 


5 




Colored males 


I 




Colored females 


5 



APPENDIX A. 



333 



Condition. Classified by Color, Sex and by Age Peeuod. 
Mortality Experience, 1911 to 1916. 











Age 


Periods. 

































Infl List 


25 to 


30 to 


35 to 


40 to 


45 to 


50 to 


55 to 


60 to 


65 to 


70 to 


75 and 


Number. 


29. 


34. 


39. 


44. 


49. 


54. 


59. 


64. 


69. 


74. 


over. 




96 


110 


105 


122 


168 


250 


365 


537 


722 


798 


634 


90 


22 


28 


44 


36 


64 


97 


135 


200 


253 


267 


218 




25 


24 


26 


45 


58 


101 


176 


266 


395 


484 


379 




22 


21 


12 


19 


26 


29 


21 


26 


29 


22 


11 




27 


37 


23 


22 


20 


23 


33 


45 


45 


25 


26 




268 


282 


313 


384 


466 


614 


803 


1100 


1270 


1218 


889 


91 


91 


107 


118 


161 


188 


246 


308 


370 


419 


389 


247 




96 


93 


115 


143 


180 


260 


383 


598 


754 


727 


579 




35 


41 


48 


44 


43 


53 


47 


68 


33 


35 


25 




36 


41 


32 


36 


45 


55 


65 


64 


64 


67 


38 




1922 


2315 


2664 


2939 


2992 


3426 


3687 


3894 


3559 


2732 


1648 


92 


788 


1053 


1215 


1387 


1418 


1533 


1563 


1575 


1349 


984 


646 




675 


630 


713 


883 


971 


1266 


1528 


1766 


1778 


1444 


949 




352 


384 


458 


418 


386 


359 


286 


291 


192 


133 


61 




207 


248 


278 


251 


217 


268 


310 


262 


240 


171 


92 




111 


119 


134 


146 


136 


160 


140 


141 


127 


84 


55 


93 


35 


45 


45 


58 


65 


69 


65 


63 


51 


33 


21 




37 


33 


51 


52 


43 


63 


56 


51 


61 


42 


25 




21 


24 


16 


26 


17 


16 


7 


9 


8 


3 


2 




18 


17 


22 


10 


11 


12 


12 


18 


7 


6 


7 




26 


36 


40 


48 


41 


43 


83 


88 


112 


139 


120 


94 


5 


9 


16 


21 


10 


17 


34 


26 


38 


47 


34 




10 


16 


9 


15 


19 


11 


33 


44 


64 


85 


82 




8 


8 


7 


7 


6 


9 


8 


10 


5 


1 


3 




2 


4 


8 


5 


7 


6 


8 


8 


6 


6 


1 




7 


13 


13 


13 


20 


19 


20 


15 


8 


12 


2 


95 


2 


8 


5 


9 


14 


14 


12 


9 


5 


10 


1 




3 


6 


7 


4 


6 


3 


6 


5 


3 




1 




1 




1 




1 


1 


1 


1 










1 










1 


1 






2 






29 


62 


67 


76 


123 


166 


186 


236 


243 


223 


116 


96 


12 


7 


18 


20 


41 


72 


67 


95 


104 


94 


41 




3 


18 


28 


28 


30 


42 


72 


83 


105 


95 


62 




8 


14 


9 


13 


19 


28 


22 


24 


16 


17 


7 




6 


13 


12 


15 


33 


24 


25 


34 


18 


17 


6 





334 



MOKTALITY STATISTICS OF INSURED WAGE EARNERS. 



Number of Deaths from Each Specified Disease or 
Metropolitan Life Insurance Company Industrial 





Cause of Deat . 


Age Periods. 


Int'l List 
Number. 


All 

ages — 1 

yr. and 

over. 


1 to 4. 


5 to 9. 


10 to 
14. 


15 to 
19. 


20 to 
24. 


97 


Pulmonary emphysema 

White males 


123 

60 

39 

18 

6 

888 

444 
205 
133 
106 

49146 

19862 

21433 

3526 

4325 


17 

4 
8 

5 

11153 

5356 

4730 

565 

502 


1 
1 

18 

8 
7 
1 
2 

2245 

1029 
944 
131 
141 


13 

1 

8 
3 
1 

1562 

735 
605 
115 
107 


3 

2 

1 

31 

13 
6 

7 
5 

1649 

738 
594 
139 

178 


3 

2 




White females 


1 




Colored males 






Colored females 




98 


Other diseases of the respira- 
tory system (tuberculosis 
excepted) 


47 




White males 


16 




White females 


17 




Colored males 


6 




Colored females 


8 


99 to 118 


V. Diseases of the 

Digestive System .... 

White males 


1676 
649 




White females 


659 




Colored males 


138 




Colored females 


230 




Diseases of the mouth and 
annexa 




99 


200 

73 
90 
15 
22 

1153 

545 

449 

65 

94 

124 

70 

45 

5 

4 

2159 

929 
806 
189 
235 


45 

28 

15 

1 

1 

277 

149 

105, 

9 

14 

16 

1 
8' 
8 

16 

7 
7 
1 

1: 


22 

10 
12 

293 

144 

124 

10 

15 

5 

4 
1 

16 

6 

7 

3 


7 

3 
3 

1 

116 

45 
54 

7 
10 

3 

2 

1 

14 

6 
5 

3 


4 

3 
1 

82 

43 
34 

1 
4 

51 

18 

25 

3 

5 


10 




White males 


5 




White females 


3 




Colored males 


1 




Colored females 


1 


100 


Diseases of the pharynx 

White males 


70 
32 




White females 


20 




Colored males 


6 




Colored females 


12 


101 


Diseases of the esophagus 

White males 


2 
1 




White females 


1 




Colored males 






Colored females 




02 


Ulcer of the stomach 


108 




White males 


39 




White females 


47 




Colored males 


7 




Colored females 


15 









APPENDIX A. 



336 



Condition. Classified by ColoRj Sex and by Age Period. 
Mortality Experience, 1911 to I&IG. 



Age Periods. 


























Int'l List 


25 to 


30 to 


35 to 


40 to 


45 to 


50 to 


55 to 


60 to 


65 to 


70 to 


75 and 


Number. 


29. 


34. 


39. 


44. 


49. 


54. 


59. 


64. 


69. 


74. 


o-'er. 




4 


3 


6 


7 


5 


10 


16 


21 


16 


16 


12 


97 




1 




2 


2 


7 


9 


10 


7 


9 


8 






1 


2 


1 


1 


2 


6 


7 


8 


7 


3 




3 


1 


4 


3 


2 


1 


1 


2 










1 






1 








2 


1 




1 




49 


49 


63 


70 


87 


109 


114 


88 


63 


47 


23 


98 


19 


24 


28 


30 


43 


61 


73 


58 


35 


22 


9 




9 


11 


9 


14 


14 


22 


18 


19 


19 


18 


6 




12 


10 


18 


14 


21 


17 


13 


4 


2 


3 


2 




9 


4 


8 


12 


9 


9 


10 


7 


7 


4 


6 




1943 


2145 


2644 


2919 


3140 


3626 


3501 


3694 


3225 


2520 


1504 


99 to 118 


670 


699 


886 


1094 


1239 


1468 


1394 


1392 


1127 


871 


515 




782 


'836 


1075 


1159 


1300 


1534 


1555 


1742 


1670 


1389 


859 




182 


231 


311 


307 


268 


284 


258 


245 


194 


105 


53 




309 


379 


372 


359 


333 


340 


294 


315 


234 


155 


77 




14 


15 


13 

4 


10 


14 


9 
2 


12 
4 


7 
3 


5 
2 


7 
2 


6 
2 


99 


2 


2 


4 




7 


"9 


7 


4 


6 


3 


6 


3 


3 


2 


4 




4 


2 




2 


1 


1 


1 






2 






1 


4 


2 


2 


3 


3 


1 


1 




1 






53 


48 


40 


41 


32 


20 


23 


20 


17 


10 


11 


100 


22 


17 


12 


26 


13 


8 


7 


10 


6 


5 


6 




20 


19 


16 


7 


10 


8 


10 


8 


6 


4 


4 




5 


3 


7 


3 


4 


3 


4 




2 




1 




6 


9 


5 


5 


5 


1 


2 


2 


3 


1 






1 


2 


4 


9 


9 


13 


15 


11 


12 


15 


7 


101 




1 


2 


5 


6 


11 


8 


6 


8 


6 


4 




"i 


1 


2 


2 
2 


2 

1 


2 


4 
2 

1 


5 


4 


7 
1 
1 


3 




165 


168 


241 


234 


224 


224 


212 


182 


176 


89 


39 


102 


62 


72 


97 


107 


114 


115 


^ 100 


82 


61 


28 


15 




59 


55 


86 


70 


70 


74 


79 


72 


85 


46 


19 




17 


17 


28 


31 


21 


13 


14 


13 


14 


7 


3 




27 


24 


30 


26 


19 


22 


19 


15 


16 


8 


2 





336 MORTALITY STATISTICS OF INSURED WAGE EARNERS. 



Number of Deaths from Each Specified Disease or 
Metropolitan Life Insurance Company Industrial 





Cause of Death. 


Age Periods. 


mt'i Last 

Numbe-. 


All 

ages — 1 
yr.and 
over. 


1 to4. 


5 to 9. 


10 to 
14. 


15 to 
19. 


20 to 
24. 


103 


Other diseases of the stomach 
(cancer excepted) 


4921 

1480 

1878 

628 

935 

6684 

3199 

2928 

314 

243 

7489 

2830 

3402 

491 

766 

12 

5 
4 
1 
2 

57 

14 

25 

7 

11 

6345 

2832 

2622 

423 

468 

2357 

788 

1287 

170 

112 


545 

249 

206 

42 

48 

6684 

3199 

2928 

314 

243 

2736 

1284 

1151 

151 

150 

2 

1 
1 

37 

12 

12 

4 

9 

212 

103 

99 

9 

1 

36 

25 
4 
6 
1 


154 

54 
60 
18 
22 

638 

278 

276 

31 

53 

2 

1 

1 

13 

1 
8 
3 
1 

734 

358 

324 

30 

22 

15 

13 

2 


75 

16 
20 
20 
•19 

157 

64 
59 
12 
22 

2 

1 
1 
2 

1 

1 

916 

470 

367 

50 

29 

13 

10 

1 
1 
1 


64 

14 
20 
15 
15 

117 

33 
39 
22 
23 

2 

2 

954 

493 

338 

58 

65 

18 

9 
4 
4 
1 


122 

21 
41 
20 




White males 




White females 




Colored males 




Colored females 


40 


104 


Diarrhea and enteritis (under 
2 years) 






White males 






White females 






Colored males 






Colored females 




105 


Diarrhea and enteritis (2 years 
and over) 


150 




White males 


40 




White females 


75 




Colored males 


11 




Colored females 


24 


106 


Ankyln.qtoTnin.sis 


1 




White males 


1 




White females 






Colored males 






Colored females 




107 


Intestinal parasites 


1 




White males 






White females 


1 




Colored males 






Colored females 




108 


Appendicitis and typhlitis 

White males 


700 
340 




White females 


257 




Colored males 


43 




Colored females 


60 


A109 


Hernia 


40 




White males 


23 




White females 


5 




Colored males 


9 




Colored females 


3 









APPENDIX A. 



537 



Condition. Classified by Colx>r.. Sex and by Age Period. 
Mortality Experience, 1911 to 1&16. 



Age Periods. 



30 to 
34. 



35 to 
39. 



195 280 



45 j 
46i 

381 



200 

59 
80 
20 
41 



25 

22. 

14 
6 



71 



56 
65 



40 to 
44. 



318 

74 
95 
67 

82 



245 

82 
90l 
26 

47 i 



470 384 

157 133 

201! 157 

43 i 40 

69 54 

I 

67 98 



32 
47 



11 



237 

77 
90 
28 
42 



339 

129 

135 

32 

43 

157 

43 
89 
11 
14 



347 



92 
101 



219 

63 
90 
22 
44 



265 

93 
129 

22 
21 

217 

52 

138 

9 

18 



60 to 
54. 



1391 

135! 

63 

110 



284 



124 
23 

49 



277 

92 
139 

28 
18 

297 



174 
16 
18 



55 to 
59. 



447; 430 



128 

139 

62 

101 



355 

122 

149 

39 

45 



179 

82 

73 

9 

15 

297 

78 

188 

21 

10 



60 to 
64. 



608 

145 

257 

33 

73 



1 

166 



79 
11 
10 

369 

118 

215 

24 

12 



65 to 
69. 



515i 510 



166 

211 

63 

95 



165 

241 

44 

60 



626 

138 

303 

29 

66 



1 

I 

1 

80 

371 
341 

t 

318 

109 

180 

19 

10 



70 to 
74. 



75 and 
over. 



450! 288 



136 

261 

19 

46 



160 

331 

17 

44 



65 

26 

33 

4 

3 

226 

78 

134 

10 

3 



79 

173 

12 

24 



552! 380 



127 

219 

11 

23 



23 



163 

69 

76 

7 

1 



Int'l List 
Number. 



103 



104 



106 



106 



107 



108 



A109 



338 



MORTALITY STATISTICS OF INSURED WAGE EARNERS. 



Number of Deaths from Each Specified Disease or 
Metropolitan Life Insurance Company Industrial 





Cause of Death. 


Age Periods. 


Infl List 
Number. 


All 

ages — I 

yr. and 

over. 


1 to 4. 


5 to 9. 


10 to 
14. 


15 to 
19. 


20 to 
24. 


B109 


Intestinal obstruction 


3162 

1039 

1580 

209 

334 

1006 

316 

437 

99 

154 

236 

75 

122 

12 

27 

11 

2 

7 
1 

1 

8064 

4426 
2715 

574 
349 

1591 

217 

1250 

36 

88 

2181 

652 

1122 

195 

212 


313 

180 

111 

9 

13 

54 

30 

16 

4 

4 

5 

2 
3 

1 
1 

19 

11 
4 
1 
3 

2 

"l 
■l 

78 

36 
26 

8 
8 


152 

75 

54 

14 

9 

29 

11 

11 

4 

3 

6 

4 
2 

25 

10 
9 
3 
3 

1 
1 

55 

29 

14 

9 

3 


86 

49 

24 

9 

4 

20 

13 
5 
1 

1 

8 

4 
4 

29 

11 

11 

4 

3 

2 

1 
1 

35 

13 

13 

3 


122 

55 
39 

14 

14 

39 

18 

16 

2 

3 

4 

1 
1 
1 

1 

29 

9 
9 
5 
6 

3 

1 
1 
1 

42 

13 
16 

8 
5 


133 




White males 


50 




White females 


61 




Colored males 


6 




Colored females 


16 


110 


Other diseases of the intestines 
White males 


43 
14 




White females 


20 




Colored males 


5 




Colored females 


4 


111 


Acute yellow atrophy of the 
liver 


30 




White males 


7 




White females 


18 




Colored males 






Colored females 


6 


112 


Hydatid tumor of the liver .... 
White males 






White females 






Colored males 






Colored females 




*113 


Cirrhosis of the liver 


55 




White males 


25 




White females 


11 




Colored males 


10 




Colored females 


9 


114 


Biliary calculi 


18 




White males 


2 




White females 


8 




Colored males 


3 




Colored females 


5 


115 


Other diseases of the liver 

White males 


74 
26 




White females 


31 




Colored males 


9 




Colored females 


8 









* Includes alcoholic cirrhosis of the liver. 



APPENDIX A. 



339 



Condition. Classipieb by ColoRj Sex and by Age Period. 
Mortality Experience, 1911 to 1916. 











Age Periods. 












25 to 
29. 


30 to 
34. 


35 to 
39. 


40 to 
44. 


45 to 
49. 


50 to 
54. 


55 to 
59. 


60 to 
64. 


65 to 
69. 


70 to 
74. 


75 and 
over. 


Int'l Ll3t 
Number. 


176 

48 
71 
14 
43 

73 

13 

41 

3 

16 

21 

4 

12 

1 

4 

3 
' 3 

186 

92 
54 
24 
16 

38 

5 

26 

3 

4 

95 

35 

39 

8 

13 


180 

38 
86 
12 

44 

69 

17 

24 

5 

23 

24 

3 

13 

2 

6 

377 

196 
112 

42 
27 

69 

9 

48 
4 
8 

139 

39 
64 
19 
17 


198 

29 

108 

17 

44 

87 

19 
38 
11 
19 

21 

3 

12 

1 

5 

2 

i 

1 

633 

321 

216 

71 

25 

91 

10 

65 

5 

11 

174 

38 
85 
26 
25 


182 

35 

98 
15 
34 

82 

22 
36 
11 
13 

16 

6 
6 
4 

2 

1 

1 

890 

473 
302 

72 
43 

136 

22 

103 

2 

9 

152 

45 
70 
19 

18 


179 

44 
98 
11 
26 

88 

27 

34 

9 

18 

17 

9 
7 

1 

1072 

608 

346 

67 

51 

171 

28 

133 

3 

7 

203 

64 
95 
25 
19 


252 

82 

132 

19 

19 

89 

23 
37 
12 

17 

17 

6 
10 

1 

1 
1 

1170 

704 

353 

79 

34 

222 

22 

181 

6 

13 

224 

64 

119 

18 

23 


260 

77 

146 

18 

19 

58 

22 

25 

4 

7 

12 

2 

7 
1 
2 

1093 

645 

354 

59 

35 

32 

207 

5 

7 

230 

60 

132 

16 

22 


309 

89 

175 

22 

23 

92 

28 
44 
10 
10 

20 

8 
9 

3 

949 

553 

304 
64 

28 

235 

30 

193 

1 

11 

229 

67 

131 

12 

19 


265 

82 

158 

15 

10 

70 

16 

37 

8 

9 

9 

4 
4 

1 

791 

408 

303 

44 

36 

167 

23 
136 

1 
7 

225 

59 

141 

11 

14 


206 

62 

126 

6 

12 

66 

26 

29 

8 

3 

18 

9 
9 

2 
2 

532 

272 

218 

23 

19 

115 

17 

93 

2 

3 

141 

37 

91 

4 

9 


149 

44 
93 

8 
4 

47 

17 

24 

2 

4 

8 

3 
5 

214 

88 

109 

6 

11 

70 

16 
53 

1 

85 

27 
55 

■3 


B109 
110 

111 
112 
113 

114 
115 



340 



MORTALITY STATISTICS OF INSURED WAGE EARNERS. 



Number ar Deaths prom Each Specified Disease or 
Metropolitan Life Insurance Company Industrial 





Cause of Death. 


Age Periods. 


Infl List 
Kumber. 


All 

ages — 1 

yr. and 

over. 


1 to 4. 


5 to 9. 


10 to 

14. 


15 to 
19. 


20 to 
24. 


116 


Diseases of the spleen 


77 

39 

34 

2 

2 

1013 

210 

490 

74 

239 

304 

121 

140 

16 

27 

64919 

24602 

28216 

5335 

6766 


6 

4 
2 

65 

27 

29 

5 

4 

4 

1 
1 
1 
1 

618 

294 

219 

60 

45 


4 

2 

1 
1 

75 

28 
36 

I 

6 

2 
4 

693 

274 

246 

37 

36 


3 

1 

2 

64 

23 

28 
7 
6 

10 

5 

4 

1 

484 

171 

244 

35 

34 


2 
2 

104 

23 

45 

4 

32 

12 

5 
4 

1 
2 

933 

305 

437 

52 

139 


3 




White males 


2 




White females 


1 




Colored males 






Colored females 




117 


Simple peritonitis (non- 
puerperal) 


105 




White males 


17 




White females 


64 




Colored males . 


7 




Colored females 


27 


118 


Other diseases of the digestive 
system (cancer and tuber- 
culosis excepted) 


11 




White males 


4 




White females 


5 




Colored males 


1 




Colored females 


1 


119 to 133 


VI. NONVENEREAL DIS- 
EASES OF THE Genito- 
urinary System and 
Annexa 


1634 




White males 


505 




White females 


814 




Colored males 


90 




Colored females 


225 




Acute nephritis 




119 


5120 

1969 

1954 

549 

648 

52067 

20762 

22650 

4234 

4421 

3 

2 
1 


316 

146 

117 

28 

25 

259 

124 
91 
29 
15 


246 

118 
94 
19 
15 

312 

141 

137 

15 

19 

1 
1 


130 

43 

65 

9 

13 

321 

114 

164 

24 

19 


201 

79 

88 
18 
16 

524 

209 

240 

31 

44 


315 




White males 


147 




White females 


121 




Colored males 


21 




Colored females 


26 


120 


Bright's disease 


835 




White males 


321 




White females 


367 




Colored males 


63 




Colored females 


84 


121 


Chyluria 






White males 






White females 






Colored males 






Colored females 





APPENDIX A. 



341 



Condition. Classified by Color, Sex and by Age Period. 
Mortality Experience, 1911 to 1916. 



Age Periods. 


























Infl List 


25 to 


30 to 


35 to 


40 to 


45 to 


50 to 


55 to 


60 to 


65 to 


70 to 


75 and 


Number. 


29. 


34. 


39. 


44. 


49. 


54. 


59. 


64. 


69. 


74. 


over. 




6 


5 


8 


7 


6 


7 


7 


4 


5 


1 


3 


116 


2 


3 


3 


5 


2 


4 


5 


2 




1 


1 




4 


2 


5 


1 
1 


3 


2 


2 


2 


5 




2 










1 


1 














105 


89 


90 


64 


47 


45 


44 


49 


28 


21 


18 


117 


7 


7 


12 


7 


10 


11 


10 


16 


2 


6 


5 




61 


44 


40 


29 


21 


24 


24 


20 


17 


11 


7 




4 


7 


13 


5 


6 


1 


2 


2 


2 


2 


3 




33 


31 


25 


23 


11 


9 


8 


11 


7 


3 


3 




22 


27 


33 


43 


29 


28 


23 


28 


20 


5 


3 


118 


9 


11 


17 


16 


10 


8 


12 


13 


7 


1 






7 


9 


11 


21 


16 


16 


10 


14 


12 


4 


2 




1 


3 


2 


3 


1 


1 


1 




1 








5 


4 


3 


3 


2 


3 




1 






i 




2184 


3016 


4048 


4841 


5614 


6437 


7367 


8374 


8205 


6541 


4030 


119 to 133 


610 


884 


1214 


1562 


1926 


2416 


2923 


3472 


3430 


2858 


1758 




1040 


1347 


1715 


2049 


2481 


2717 


3089 


3466 


3596 


2886 


1870 




132 


237 


363 


456 


506 


617 


698 


732 


646 


479 


195 




402 


548 


756 


774 


701 


687 


657 


704 


533 


318 


207 




330 


367 


41'4 


439 


429 


450 


446 


397 


312 


219 


109 


119 


133 


153 


154 


146 


148 


143 


166 


150 


123 


82 


38 




122 


127 


148 


174 


175 


178 


144 


152 


121 


87 


41 




30 


41 


50 


53 


50 


51 


59 


47 


33 


28 


12 




45 


46 


62 


66 


56 


78 


77 


48 


35 


22 


18 




1187 


1883 


2719 


3605 


4472 


5491 


6435 


7424 


7252 


5776 


3572 


120 


442 


691 


1001 


1371 


1709 


2174 


2590 


3039 


2934 


2417 


1485 




630 


770 


1088 


1427 


1859 


2282 


2751 


3158 


3335 


2699 


1752 




79 


176 


286 


367 


420 


507 


569 


613 


524 


375 


156 




136 


246 


344 


440 
1 

1 


484 


528 


525 


614 


459 

1 

1 


285 


179 


121 



342 



MOETALITY STATISTICS OF INSUKED WAGE EARNEKS. 



Number of Deaths from Each Specified Disease or 
Metropolitan Life Insurance Company Industrial 



Int'l List 
Number. 



Cause of Death. 



Age Periods. 



All 

ages — 1 

yr. and 

over. 



10 to 
14. 



15 to 
19. 



122 



123 



124 



125 



126 



127 



128 



Other diseases of the kidneys 
and annexa 

White males 

White females 

Colored males 

Colored females 

Calculi of the urinary passages 

White males 

White females 

Colored males 

Colored females 

Diseases of the bladder 

White males 

White females 

Colored males 

Colored females 

Diseases of the urethra, 

urinary abscess, etc 

White males 

White females 

Colored males 

Colored females 

Diseases of the prostate 

White males 

White females 

Colored males 

Colored females 

Nonvenereal diseases of the 
male genital organs 

White males 

White females 

Colored males 

Colored females 

Uterine hemorrhage (non- 
puerperal) 

White males 

White females 

Colored males 

Colored females 



861 

302 

401 

86 

72 

322 

174 

116 

24 



611 

320 

141 

109 

41 



202 

110 
13 

77 



1162 
928 
234 

56 
35 
21 

67 

53 
14 



16 



23 



APPENDIX A. 



343 



Condition. Classifikd by Color^ Sex and by Age Period. 
Mortality Experience, 1911 to 1916. 











Age 


Periods 


. 


































Int'l List 


25 to 


30 to 


35 to 


40 to 


45 to 


50 to 


55 to 


60 to 


65 to 


79 to 


75 and 


Number. 


29. 


34. 


39. 


44. 


49. 


54. 


59. 


64. 


69. 


74. 


over. 




49 


46 


75 


76 


66 


83 


75 


76 


82 


60 


44 


122 


14 


14 


23 


21 


19 


23 


26 


29 


36 


28 


17 




27 


25 


40 


34 


36 


43 


32 


32 


31 


25 


21 




3 


1 


8 


14 


8 


10 


10 


9 


5 


6 


3 




5 


6 


4 


7 


3 


7 


7 


6 


10 


1 


3 




15 


21 


30 


18 


22 


29 


37 


43 


29 


25 


12 


123 


9 


11 


17 


5 


11 


13 


18 


24 


18 


13 


7 




4 


7 


13 


10 


10 


13 


15 


15 


8 


7 


4 




2 


2 
1 




3 


1 


1 

2 


4 


4 


2 
1 


5 


1 




19 


13 


15 


21 


37 


36 


50 


87 


113 


121 


74 


124 


3 


6 


4 


6 


13 


13 


27 


48 


68 


78 


43 




6 


4 


5 


6 


10 


12 


7 


17 


20 


23 


23 




7 


2 


4 


5 


9 


9 


11 


17 


21 


16 


5 




3 


1 


2 


4 


5 


2 


5 


5 


4 


4 


3 




15 


20 


21 


12 


29 


20 


31 


20 


21 


2 


5 


125 


5 


8 
2 


8 
2 


4 


13 


14 


18 
2 


16 


15 


2 


3 

1 




1 


1 


3 




9 


10 


11 


7 


12 

1 


6 


10 

1 


4 


6 




1 




3 


2 


6 


14 


16 


61 


108 


200 


282 


284 


181 


126 


2 




5 


8 


11 


30 


77 


163 


229 


236 


164 




1 


2 


1 


6 


"5 


31 


31 


'37 


53 


48 


17 




3 


4 


4 


4 


2 


8 


5 


4 


9 


3 


1 


127 


2 


1 


1 


1 


1 


6 


1 


3 


7 


2 


1 




1 


3 


3 


3 


1 


2 


4 


1 


2 


1 






9 


11 


9 


8 


7 


4 


3 


3 


2 


1 


2 


128 


7 


"9 


"e 


6 


6 


"3 


"3 


3 






"2 




2 


2 


3 


2 


1 


1 






2 


1 







344 



MORTALITY STATISTICS OF INSURED WAGE EARNERS. 



Number of Deaths from Each Specified Disease or 
Metropolitan Life Insurance Company Industrial 



Int'l List 
Number. 



Age Periods. 



Cause of Death. 



All 

ages — 1 

yr.and 

over. 



10 to 
14. 



15 to 
19. 



20 to 
24. 



129 



130 



131 



Uterine tumor (noncancerous). 



White males .... 
White females . . 
Colored males . . 
Colored females. 



Other diseases of the uterus. . . . 



White males. . . . 
White females . . 
Colored males. . 
Colored females. 



Cysts and other tumors of 
the ovary 



White males. . . . 
White females . . 
Colored males . . 
Colored females. 



132 



Salpingitis and other diseases of 
the female genital organs. 



133 



134 to 141 



134 



White males. . . . 
White females . . 
Colored males. . 
Colored females. 



Nonpuerperal diseases of the 
breast (cancer excepted) . 



White males. . . . 
White females . . 
Colored males. . 
Colored females. 



VII. The Puerpebal 

State 



White males. . . . 
White females . . 
Colored males. . 
Colored females. 



Accidents of pregnancy . 



White males. . . . 
White females . . 
Colored males. . 
Colored females. 



1335 

705 
630 

786 

600 
186 

608 

400 
108 

1782 

1151 
631 

37 

2 
30 

5 

10151 

8359 
1792 



885 

712 
173 



6 
1 

103 

54 
49 



979 

660 
319 



17 

9 

8 
72 

60 
12 

30 

27 
3 

282 

196 
86 



1 

2246 

1865 
381 



161 

122 
39 



APPENDIX A, 



345 



Condition. Classified by ColoRj Sex and by Age Period. 
Mortality Experience, 1911 to 1916. 



Age Periods. 




25 to 
29. 


30 to 
34. 


35 to 
39. 


40 to 
44. 


45 to 
49. 


50 to 
54. 


55 to 
59. 


60 to 
64. 


65 to 
69. 


70 to 
74. 


75 and 
over. 


Int'I List 
Number. 


53 


139 


253 


265 


270 


123 


85 


56 


30 


24 


12 


129 


18 


56 


89 


128 


178 


84 


58 


37 


17 


20 


9 




35 


83 


164 


137 


92 


39 


27 


19 


13 


4 


3 




112 


110 


101 


97 


83 


52 


39 


28 


25 


7 


8 


130 


76 


82 


75 


74 


69 


41 


32 


21 


23 


6 


"7 




36 


28 


26 


23 


14 


11 


■7 


7 


2 


1 


1 




52 


56 


76 


67 


60 


39 


29 


24 


39 


18 


9 


131 


33 


40 


53 


52 


51 


26 


28 


22 


■33 


18 


9 




19 


16 


23 


15 


9 


13 


1 


2 


6 








332 


342 


318 


210 


117 


37 


21 


8 


7 






132 


211 


223 


'"' 


134 


82 


31 


14 


6 


6 








121 


119 


127 


76 


35 


6 


"7 


2 


1 








5 


2 


7 


4 


4 


4 


3 


4 


1 


1 


1 


133 


* 6 


2 


1 
5 

1 


3 

1 


1 
2 

1 


4 


'3 


3 

1 


1 


1 


1 




2357 


2171 


1644 


659 


76 


6 


1 










134 to 141 


1986 


1822 


1392 


563 


62 


3 


i 












371 


349 


252 


96 


14 


3 














218 


220 


173 


59 


9 


1 












134 


178 


179 


141 


48 


7 
















40 


41 


32 


11 


2 


1 















246 



MORTALITY STATISTICS OF INSURED WAGE EARNERS. 



Number of Deaths from Each Specified Disease or 
Metropolitan Life Insurance Company Industrial 





Cause of Death. 


Age Periods. 


Infl List 
Number. 


All 

ages — 1 
yr. and 
over. 


1 to 4. 


5 to 9. 


10 to 
14. 


IS to 
19. 


20 to 
24. 


135 


Puerperal hemorrhage 


791 

681 

110 

1036 

838 

198 

4348 

3512 
836 

2675 

2249 
426 

369 

327 
42 

43 

36 

7 
4 

4 






3 

2 

"l 

4 

1 
3 

4 

i 

3 


25 

22 

3 

61 

38 

23 

449 

291 
158 

385 

259 
126 

13 

12 
1 

2 

1 
1 
1 

1 


109 




White males 






White females 


86 




Colored males 






Colored females 


23 


130 


Other accidents of labor 

White males 


200 




White females 


159 




Colored males 






Colored females 


41 


137 


Puerperal septicemia 


1036 




White males 






White females 


849 




Colored males 






Colored females 


187 


138 


Puerperal albuminuria and 

convulsions 


671 




White raales ....•• 

White females 


684 




Colored males 






Colored females 


87 


139 


Puerperal phlegmasia alba 
dolens, embolus, sudden 
death 


61 




White males 






White females 


57 




Colored males 






Colored females 


4 


140 


Following childbirth (not 

otherwise defined) 


8 




White males 






White females 


8 




Colored males 






Colored females 




141 


Puerperal diseases of the breast 
White males 






White females 






Colored males 






Colored females 

















APPENDIX A. 



347 



Condition. Classified by ColoRj Sex and bt Age Peeiod. 
Mortality Experience, 1911 to 1916. 











Age Periods. 












25 to 
29. 


30 to 
34. 


35 to 
39. 


40 to 
44. 


45 to 
49. 


50 to 
54. 


55 to 
59. 


60 to 
64. 


65 to 
69. 


70 to 

74. 


75 and 
over. 


Int'l List 
Number. 


171 


188 


199 


87 


11 


1 












135 


147 


160 


176 


79 


10 


1 














24 


28 


23 


"8 


1 
















233 


235 


196 


95 


10 


3 












136 


193 


191 

■ 


162 


'84 


7 


2 














40 


44 


34 


11 


3 


1 














1087 


926 


602 


221 


22 




1 










137 


896 


771 


502 


185 


16 




1 












191 


155 


100 


36 


6 
















542 


509 


383 


164 


17 












•- 


138 


484 


439 
70 


327 
56 


140 


15 
















58 


24 


2 




92 


82 


85 


29 


6 


1 












139 


76 


74 


79 


23 


6 
















16 


"8 


6 


"e 




1 














12 


11 


5 


4 


1 














140 


10 


8 


4 


4 


1 
















2 


3 


1 




















2 




1 


















141 


2 




1 





















348 



MORTALITY STATISTICS OF INSURED WAGE EARNERS. 



Number of Deaths from Each Specified Disease or 
Metropolitan Life Insurance Company Industrial 





Cause of Death. 


Age Periods. 


Inf 1 List 
Number. 


All 

ages — 1 

yr. and 

over. 


1 to4. 


5 to 9. 


10 to 
14. 


15 to 
19. 


20 to 
24. 


142>to 145 


VIII. Diseases of the 
Skin and of the 
Cellular Tissue 

White males 


1529 

632 
602 
134 
161 


84 

35 

45 
2 
2 


41 

13 

24 

3 

1 


23 

11 
9 

2 
1 


37 

23 
7 
5 
2 


41 
19 




White females 


11 




Colored males 


5 




Colored females 


6 








142 


681 

248 

278 

73 

82 

215 

133 

70 
3 
9 

360 

176 

126 

37 

21 

273 

75 

128 

21 

49 

1266 

649 

480 

64 

73 


23 

10 
12 

1 

8 

4 
4 

41 

15 

24 

2 

12 

6 
5 

1 

148 

77 

62 

3 

6 


18 

4 

11 

3 

19 

7 
11 

1 

4 

2 

2 

180 

78 

92 

4 

6 


3 

1 

1 

, 1 

10 

6 
4 

8 

3 
4 
1 

2 
1 

1 

180 

112 

61 

3 

4 


5 

2 

3 

9 

7 
1 
1 

22 

14 
5 
1 
2 

1 

1 

126 

90 

27 
6 
3 


12 




White males 


5 




White females 


3 






3 




Colored females 


1 


143 


Furuncle 


7 






4 




White females 


1 




Colored males 






Colored females 


2 


144 


Acute abscess 

White males 


16 
9 




White females 


3 




Colored males 


2 




Colored females 


2 


145 


Other diseases of the skin and 


6 




White males 


1 




White females 


4 




Colored males 








1 


146 to 149 


IX. Diseases of the Bones 
AND OF the Organs 
OF Locomotion 

White males 


58 
29 




White females 


21 






2 






6 




Diseases of the bones (tuber- 




146 


1109 

576 

415 

58 

60 


140 

73 

58 

3 

6 


169 

74 

85 

4 

6 


168 

104 

58 

3 

3 


116 

81 

26 

6 

3 


53 




White males 


27 




White females 


20 




Colored males 


2 




Colored females 


4 



APPENDIX A. 



349 



Condition. Classified by ColoRj Sex and by Age Peeiod. 
Mortality Experience, 1911 to 1916. 



Age Periods. 


























Infl List 


25 to 


30 to 


35 to 


40 to 


45 to 


50 to 


55 to 


60 to 


65 to 


70 to 


75 and 


Number. 


29. 


34. 


39. 


44. 


49. 


64. 


59. 


64. 


69. 


74. 


over. 




32 


67 


55 


82 


103 


125 


128 


182 


183 


204 


142 


142 to 145 


15 


28 


25 


34 


49 


53 


46 


69 


63 


82 


67 




11 


19 


18 


28 


34 


41 


50 


75 


82 


88 


60 






10 


4 


12 


9 


17 


12 


15 


15 


15 


8 




6 


10 


8 


8 


11 


14 


20 


23 


23 


19 


7 




2 


38 


14 


18 


26 


62 


47 


99 


109 


136 


99 


142 


1 


5 


6 


9 


8 


18 


19 


33 


32 


50 


45 




1 


6 


5 


4 


11 


16 


15 


43 


49 


60 


41 






3 


1 


2 


3 


11 


4 


10 


10 


12 


7 






4 


2 


3 


4 


7 


9 


13 


18 


14 


6 




6 


10 


11 


19 


25 


33 


21 


18 


18 


13 


7 


143 


5 


6 


7 


10 


15 


16 


14 


11 


11 


12 


5 




1 


4 


3 

1 


8 
1 


7 
3 


15 

2 


5 

1 
1 


7 


7 


1 


2 




11 


31 


17 


31 


28 


24 


27 


38 


19 


17 


11 


144 


6 


16 


9 


12 


21 


14 


6 


19 


10 


7 


8 




4 


6 


5 


11 


3 


5 


14 


14 


7 


8 


2 






6 


1 


7 


2 


4 


6 


3 


1 


1 






1 


3 


2 


1 


2 


1 


1 


2 


1 


1 


1 




13 


8 


13 


14 


24 


16 


33 


27 


37 


38 


25 


145 


3 


1 


3 


3 


5 


5 


7 


6 


10 


13 


9 




6 


3 


5 


5 


13 


5 


16 


11 


19 


19 


15 






1 


1 


3 


4 


2 


1 


2 


4 


2 


1 




5 


3 


4 


3 


2 


4 


9 


8 


4 


4 






74 


50 


51 


50 


64 


55 


62 


54 


49 


37 


28 


146 to 149 


39 


18 


19 


20 


35 


23 


27 


28 


22 


21 


11 




28 


19 


20 


23 


18 


20 


25 


20 


21 


10 


13 




4 


7 


8 


4 


5 


3 


5 


3 


3 


3 


1 




3 


6 


4 


3 


6 


9 


6 


3 


3 


3 


3 




58 


43 


43 


42 


54 


44 


49 


42 


38 


27 


23 


146 


32 


16 


16 


17 


30 


18 


21 


23 


18 


18 


9 




20 


16 


16 


19 


15 


16 


20 


15 


14 


6 


11 




4 


7 


7 


3 


5 


2 


4 


3 


3 


1 


1 




2 


5 


4 


3 


4 


8 


4 


1 


3 


2 


2 





350 



MORTALITY STATISTICS OF INSURED WAGE EARNERS. 



Number of Deaths from Each SPECiFiia) Disease or 
Metropolitan Life Insurance Company Industrial 





Cause of Death. 


Age Periods. 


Int'l List 
Number. 


au 

ages — 1 

yr.and 

over. 


lto4. 


6 to 9. 


10 to 
14. 


15 to 
19. 


20 to 
24. 


147 


Diseases of the joints (tubercu- 
losis and rheumatism ex- 


120 

53 

53 

5 

9 

6 
5 

1 

31 

15 
12 

1 
3 

320 

177 

121 

15 

7 


6 

2 
4 

2 
2 

181 

103 

63 

11 

4 


9 

3 
6 

2 

1 

1 

66 

32 

30 

3 

1 


12 

8 
3 

1 

21 

14 
6 

1 


7 

6 

1 

1 
1 

2 
2 

15 

10 
5 


4 






2 










Colored males 






Colored females 


2 


148 


Amputations 






White males 






White females 
















149 


Other diseases of the organs 


1 










White females 


1 


' 








Colored females 




150 


X. Malformations 


7 
6 






1 
















Congenital malformations (still- 
births not included) 






150 


320 

177 

121 

15 

7 

3480 

994 

1889 

220 

377 


181 

103 

63 

11 

4 


66 21 
321 14 


15 
10 


7 
6 




White females 


30 
3 
1 


6 

1 


6 1 
















164 


XII. Old Age 






White males 






White females 






Colored males 
















164 


3480 

994 

1889 

220 

377 


. . . 






























Colored females 





APPENDIX A. 



351 



CoNorriON. Classified by Coloe, Sex and by Age Period. 
Mortality Experience, 1911 to 1916. 



Age Periods. 




25 to 
29. 


30 to 
34. 


35 to 
39. 


40 to 
44. 


45 to 
49. 


50 to 
54. 


65 to 
59. 


60 to 
64. 


65 to 
69. 


70 to 
74. 


75 and 
over. 


Infl Llat 
Number. 


13 

5 

8 

3 

2 

1 

6 
3 


6 

3 
2 

1 

1 
1 

11 

3 

8 


8 

3 

4 

1 

4 

3 

1 


7 

2 
4 

1 

1 
1 

3 
1 


9 

6 
2 

2 

1 
1 

3 
1 


8 

3 
3 
1 
1 

3 

2 
1 

1 

1 


10 
4 

5 
1 

3 

2 

1 


8 

4 
3 

1 

1 
1 

3 

2 
1 

1 


6 

2 
4 

5 

2 
3 


5 

4 

1 

1 
1 

4 
2 

1 

1 


2 
1 

1 

3 

1 
2 

1 
1 


147 
148 

149 
160 


2 
1 


1 
1 


2 




6 

3 
2 

1 


11 

3 

8 


4 

3 
1 


3 

1 
1 

1 


3 

1 
2 

6 

1 
1 
2 
2 


1 
1 

20 

6 
9 

4 

1 


72 

16 

33 

8 

15 


1 
1 

287 

65 

132 

32 

58 


605 

159 
317 

48 
81 


1167 

344 

652 

71 

100 


1 
1 

1323 

403 

745 

55 

120 


160 

154 










6 

1 
1 
2 
2 


20 

6 
9 
4 

1 


72 

16 

33 

8 

16 


287 

65 

132 

32 

58 


605 

159 

317 

48 

81 


1167 

344 

652 

71 

100 


1323 

403 

745 

55 

120 


154 



362 



MORTALITY STATISTICS OF INSURED WAGE EARNERS. 



Number oi Deaths from Each Specified Disease or 
Metropolitan Life Insurance Company Industrial 





Cause ol Death. 


Age Periods. 


Int'l List 
Number. 


All 

ages— 1 

yr. and 

over. 


1 to4. 


5 to 9. 


10 to 
14. 


15 to 
19. 


20 to 
24. 


155 to 186 


XIII. External Causes*: 
White males 


50712 

31381 

11618 

5610 

2103 


4259 

2160 

1662 

238 

199 


3788 

2344 

1064 

216 

164 


2809 

2004 

444 

281 

80 


4113 

2717 
712 
556 
128 


4847 
3174 




White females 


747 






670 




Colored females 


256 




Suicide (total) 




165 to 163 


6542 

4309 

1748 

308 

177 

2352 

1280 

874 

89 

109 

1040 

633 

386 

14 

7 

761 

626 

106 

24 

5 

316 

176 

109 

16 

15 

1519 

1210 
152 
129 

28 






27 

15 

8 
2 
2 

8 

1 
6 
1 

2 

1 
1 

7 
7 

1 

1 

8 

6 

1 
1 


364 

135 

195 

16 

18 

199 

45 
137 

4 
13 

26 

12 
14 

23 

16 
3 
3 
1 

20 

4 
14 

1 

1 

81 

60 

23 

6 

2 


707 




White males 


391 




White females 


226 






45 




Colored females 


45 


155 


Suicide by poison 


338 




White males 


145 




White females 


152 






9 






32 


156 


Suicide by asphyxia 

White males 


47 
29 




White females 


16 












2 


157 


Suicide by hanging or 
strangulation 


42 




White males 


30 




White females 


7 




Colored males 


5 




Colored females 




158 


Suicide by drowning 

White males 


24 
9 




White females 


7 






4 






4 


159 


Suicide by firearms 


225 
159 




White females 


38 






24 






4 









* Includes war deaths (1,149). 



APPENDIX A. 



353 



Condition. Classified by ColoEj Sex and by Age Period. 
Mortality Experience, 1911 to 1916. 



Age Periods. 


























Int'l List 


25 to 


30 to 


35 to 


40 to 


45 to 


50 to 


55 to 


60 to 


65 to 


70 to 


75 and 


Number. 


29. 


34. 


39. 


44. 


49. 


54. 


59. 


64. 


69. 


74. 


over. 




4245 


3813 


3460 


3189 


2983 


2968 


2722 


2574 


2177 


1692 


1073 


155 to 186 


2598 


2303 


2183 


2106 


2004 


1969 


1811 


1600 


1210 


797 


401 




622 


615 


521 


524 


544 


628 


634 


742 


774 


780 


605 




784 


676 


600 


432 


329 


281 


205 


154 


108 


54 


26 




241 


219 


156 


127 


106 


90 


72 


78 


85 


61 


41 




724 


711 


666 


640 


598 


620 


527 


431 


304 


152 


71 


155 to 163 


421 


401 


425 


429 


433 


466 


413 


347 


254 


118 


61 




218 


235 


170 


173 


139 


128 


97 


72 


44 


33 


10 




52 


48 


48 


26 


19 


20 


14 


12 


6 








33 


27 


23 


12 


7 


6 


3 






1 






337 


314 


227 


240 


157 


178 


135 


113 


68 


30 


8 


165 


159 


157 


134 


147 


98 


126 


98 


86 


59 


19 


6 




142 


115 


67 


76 


54 


43 


34 


26 


9 


11 


2 




16 


22 


12 


12 


4 


6 


2 


1 










20 


20 


14 


5 


1 


3 


1 












87 


103 


122 


122 


115 


129 


113 


77 


57 


33 


7 


156 


60 


50 


59 


66 


71 


85 


82 


57 


45 


22 


4 




33 


51 


60 


54 


43 


43 


29 


17 


11 


11 


3 




3 


1 


2 


1 


1 




2 


3 


1 








1 


1 


1 


1 




1 














40 


51 


58 


58 


74 


86 


91 


97 


76 


35 


23 


157 


34 


36 


51 


44 


60 


73 


71 


85 


67 


32 


20 




4 


13 


2 


14 


13 


10 


15 


10 


9 


3 


3 




1 


2 


3 






3 


5 


2 










1 




2 




1 
















31 


33 


29 


25 


30 


37 


20 


31 


22 


8 


5 


168 


20 


14 


14 


15 


18 


23 


13 


23 


13 


5 


6 




7 


17 


11 


7 


8 


14 


6 


7 


9 


2 






2 


1 


2 


3 


2 






1 










2 


1 


2 




2 




1 






1 






175 


156 


162 


132 


152 


130 


122 


80 


52 


29 


15 


159 


128 


109 


122 


111 


134 


113 


113 


73 


49 


28 


15 


, 


14 


25 


13 


14 


9 


7 


5 


2 


1 


1 




j 


26 


18 


24 


4 


8 


8 


3 


6 


2 








7 


4 


3 


3 


1 


2 


1 













354 



MORTALITY STATISTICS OF INSURED WAGE EARNERS. 



Number cf Deaths from Each Specified Disease or 
Metropolitan Life Insurance Company Industrial 





Cause of Death. 


Age Periods. 


Infl List 
Number. 


All 

ages — 1 

yr. and 

over. 


lto4. 


5 to 9. 


10 to 

14. 


15 to 
19. 


20 to 
24. 


160 


Suicide by cutting or 

piercing instruments 


346 

272 

47 

24 

3 

107 

58 

38 

7 

4 

33 

25 
5 
3 

68 

29 
31 

2 
6 

39268 

24794 
9356 
3705 
1413 

622 

265 

248 
45 
64 

1144 

515 
475 

82 
72 


4228 

2149 

1644 

236 

199 

183 

94 
73 

7 
9 

357 

162 

147 

30 

18 


3740 


1 
1 

2720 


3 

1 

1 
1 

5 

3 

2 

3 
2 
1 

4 

2 

1 

1 

3241 

2308 

459 

412 

62 

24 

8 

12 

1 

3 

49 

14 
32 

1 
2 


15 
11 






3 




Colored males 


1 








.161 


Suicide by jumping from 
high places 


4 






2 






1 




Colored males 


1 




Colored females 




162 


Suicide by crushing 

White males 


6 

4 




White females 


1 






1 








163 




6 




White males 


2 




White females 


1 




Colored males 






Colored females 


3 




Accidents or undefined vio- 
lence (total) * 


3027 




White males 


2323 1963 

10481 420 

209 264 

160 73 

1 

87' 38 

42' 18 

36j 14 

4 3 

5, 3 


2170 




White females 


427 






333 






97 


164 


Poisoning by food 


28 




White males 


11 




White females 


10 






5 






2 


165 


Other acute poisonings 


61 
34 


16 
9 


91 
30 






16| 5 

7\ ... 


44 






6 




Colored females 


4 


' , 2 


11 



* Includes titles 164 to 181 inclusive, 185 and 186, but excludes "war 



APPENDIX A. 



355 



Condition. Classified by ColoRj Sex and by Age Period. 
Mortality Experience, 1911 to 1916. 



Age Periods. 


























Infl List 


25 to 


30 to 


35 to 


40 to 


45 to 


50 to 


55 to 


60 to 


65 to 


70 to 


75 and 


Number. 


29. 


34. 


39. 


44. 


49. 


54. 


59. 


64. 


69. 


74. 


over. 




25 


28 


42 


46 


53 


44 


30 


21 


20 


10 


9 


160 


18 


22 


35 


37 


42 


35 


23 


17 


14 


9 


8 


, 


4 


3 


4 


4 


6 


7 


5 


4 


4 


1 


1 




3 


3 


3 


4 
. 1 


3 
2 


2 


2 




2 








16 


13 


18 


11 


9 


9 


5 


5 


7 


4 


1 


161 


7 


9 


6 


6 


6 


7 


3 


2 


6 


1 


1 




7 


4 


9 


2 


2 


2 


2 


3 


1 


3 






1 




2 


1 


1 








1 








1 




1 


2 


















3 


2 


3 


1 


2 


3 


6 


2 


2 




1 


162 


2 


2 


2 




1 


2 


6 


2 


2 




1 




1 




1 


1 


1 


1 














10 


11 


5 


6 


6 


4 


6 


6 




3 


2 


163 


3 


2 


2 


3 


3 


2 


6 


2 




2 


1 




6 


7 

1 


3 


2 


3 


1 
1 


1 


3 




1 


1 




1 


1 






















2574 


2327 


2274 


2195 


2175 


2203 


2105 


2089 


1843 


1532 


995 




1787 


1582 


1546 


1522 


1482 


1434 


1347 


1226 


940 


675 


340 




324 


317 


304 


307 


383 


475 


527 


659 


726 


743 


593 




369 


339 


340 


284 


227 


220 


169 


132 


94 


64 


23 




94 


89 


84 


82 


83 


74 


62 


72 


83 


60 


39 




25 


37 


23 


33 


26 


30 


27 


21 


20 


12 


8 


164 


10 


12 


7 


13 


10 


10 


9 


10 


6 


4 


1 




9 


15 


8 


8 


10 


9 


11 


8 


13 


6 


7 




2 


3 


3 


4 


2 


6 


4 






1 






4 


7 


5 


8 


4 


5 


3 


3 


1 


2 






104 


86 


67 


66 


60 


47 


43 


41 


24 


23 


9 


165 


38 


33 


19 


31 


35 


29 


21 


29 


11 


15 


6 




49 


41 


38 


21 


19 


12 


19 


10 


12 


6 


4 




11 


4 


6 


7 


2 


3 


3 






2 






6 


8 


4 


7 


4 


3 




2 


i 









deaths" (x-186). 



356 



MORTALITY STATISTICS OF INSUEED WAGE EARNERS. 



Number of Deaths from Each Specified Disease oe 
Metropolitan Life Insurance Company Industrial 





Cause ol Death. 


Ali 

ages — 1 
yr. and 
over. 




Age Periods. 






Infl List 
Number. 


1 to 4. 


6 to 9. 


10 to 
14. 


15 to 
19. 


20 to 
24. 


166 




676 

257 

185 

62 

72 

4714 

1545 

2393 

255 

521 

1431 

843 

485 

69 

34 

5757 

4310 
661 

708 

78 

1029 

637 
89 

248 
55 

93 

51 

15 

21 

6 

6917 

4021 

2297 

405 

194 


101 

45 
30 
12 
14 

1977 

912 
828 
116 
121 

46 

21 

21 

2 

2 

280 

194 

74 

9 

3 

39 

19 

11 

4 

5 

9 

3 
6 

454 

249 

159 

31 

15 


64 

28 

24 

1 

11 

760 

227 

410 

29 

94 

48 

24 
23 

1 

742 

627 

77 

33 

5 

100 

63 

14 

18 

5 

10 

8 
1 
1 

311 

204 

78 

23 

6 


30 

7 

15 

5 

3 

174 

35 

108 

8 

23 

53 

36 

13 

2 

2 

915 

717 

79 

110 

9 

209 

162 

9 

33 

5 

10 

8 
2 

201 

145 

32 

16 

8 


24 

10 

11 

3 

130 

29 

73 

8 

20 

68 

31 

32 

3 

2 

1031 

737 

128 

157 

9 

244 

161 
23 

58 
2 

5 

2 
1 
2 

208 

158 

27 

17 

6 


34 




White males 


11 




White females . 


13 




Colored males 


6 




Colored females 


4 


167 


Burns (conflagration 

excepted) 


162 




White males 


38 




White females 


86 




Colored males . 


g 




Colored females 


29 


168 


Absorption of deleterious 
gases (conflagration 
excepted) 


97 




White males 


59 




White females 


28 




Colored males 


5 




Colored females 


5 


169 


Accidental drowning 

White males 


694 
479 




White females 


113 




Colored males 


92 




Colored females 


10 


170 


Traumatism by firearms. . . 
White males 


136 

77 




White females 


4 




Colored males 


41 




Colored females 


14 


171 


Traumatism by cutting or 
piercing instruments 

White males 


9 
4 




White females 


1 




Colored males 


4 




Colored females 




172 


Traumatism by fall 

White males 


241 
191 




White females 


24 




Colored males 


17 




Colored females 


g 









APPENDIX A. 



357 



Condition. Classified bt Color, Sex and by Age Period. 
Mortality Experience, 1911 to 1916. 











Age Periods. 


































Infl List 


25 to 


30 to 


35 to 


40 to 


45 to 


50 to 


55 to 


60 to 


65 to 


70 to 


75 and 


Number. 


29. 


34. 


39. 


44. 


49. 


54. 


59. 


64. 


69. 


74. 


over. 




25 


35 


42 


33 


34 


31 


31 


27 


28 


24 


13 


166 


12 


18 


27 


20 


19 


18 


15 


6 


9 


10 


2 




8 


5 


9 


8 


7 


6 


10 


11 


9 


10 


9 




3 


6 


3 


2 


7 


4 


2 


5 


3 


1 






2 


7 


3 


3 


1 


3 


4 


5 


7 


3 


2 




145 


123 


133 


135 


140 


170 


146 


159 


149 


124 


87 


167 


28 


29 


36 


28 


33 


36 


32 


29 


17 


24 


12 




84 


66 


65 


79 


81 


99 


88 


96 


93 


78 


59 




9 


11 


10 


13 


6 


6 


4 


9 


9 


5 


3 




24 


17 


22 


15 


20 


29 


22 


25 


30 


17 


13 




94 


100 


97 


113 


123 


127 


132 


127 


96 


68 


42 


168 


47 


57 


55 


81 


77 


74 


83 


80 


58 


40 


20 




34 


27 


30 


22 


34 


44 


46 


46 


35 


28 


22 




8 


9 


10 


8 


9 


8 


2 


1 


2 








5 


7 


2 


2 


3 


1 


1 




1 








432 


328 
224 


259 
184 


241 


232 


197 
154 


156 
134 


109 

88 


82 
68 


40 
34 


19 
16 


169 


299 


188 


167 




42 


28 


20 


17 


27 


20 


11 


10 


9 


3 


3 




84 


71 


47 


31 


30 


20 


8 


9 


4 


3 






7 


5 


8 


5 


8 


3 


3 


2 


1 








82 


69 


58 


34 


10 


17 


7 


13 


7 


4 




170 


38 


35 


27 


17 


5 


13 


5 


8 


6 


1 






3 


3 


8 


2 


3 


2 




4 


1 


2 






34 


28 


17 


9 




2 


2 


1 




1 






7 


3 


6 


6 


2 
















12 


7 


6 


6 


4 


5 


4 


4 


1 




1 


171 


4 


6 


2 


3 


2 


2 


3 


4 






1 




1 




1 








1 




1 








7 


2 


2 
1 


2 
1 


-2 


3 














267 


341 


410 


419 


457 


504 


549 


653 


687 


707 


508 


172 


199 


257 


304 


318 


313 


324 


330 


338 


289 


255 


147 




30 


49 


52 


58 


98 


136 


169 


271 


356 


414 


344 




26 


28 


46 


35 


35 


33 


35 


27 


22 


9 


6 




12 


7 


8 


8 


11 


11 


15 


17 


20 


29 


12 





358 



MORTALITY STATISTICS OF INSURED WAGE EARNERS. 



Number of Deaths from Each Specified Disease or 
Metropolitan Life Insurance Company Industrial 





Cause of Death. 


Age Periods. 


Int'l List 
Number. 


All 

ages — 1 

yr. and 

over. 


1 to 4. 


6 to 9. 


10 to 
14. 


15 to 
19. 


20 to 
24. 


A173 


Traumatism in mines 

White males 


612 

505 

3 

104 

48 

40 

1 
7 

905 

720 

32 

148 

5 

4485 

3598 

301 

527 

59 

1600 

1130 

312 

124 

34 

2507 

1737 

585 

139 

46 

1658 

1226 

242 

170 

20 


7 

4 
2 

1 

48 

32 
15 

1 

120 

63 

51 

3 

3 

165 

96 

61 

6 

2 

170 

97 

66 

4 

3 


1 

1 

10 

7 
2 
1 

171 

132 

27 

11 

1 

186 

120 

52 

10 

4 

625 

423 

160 

32 

10 

273 

202 

50 

17 

4 


15 

9 
1 
5 

1 
1 

30 

26 

1 
2 

1 

228 

185 

19 

22 

2 

104 

78 

17 

6 

3 

335 

257 

53 

20 

5 

107 

83 

14 

9 

1 


100 
89 
11 

8 
8 

140 

112 

9 

16 

3 

508 

409 

32 

62 

5 

96 

66 

14 

14 

2 

177 

132 

33 

11 

1 

112 

82 

13 

14 

3 


79 
70 




White females 






Colored males 


9 




Colored females 




B173 


Traumatism in quarries. . . . 
White males 


2 
2 




White females 






Colored males 






Colored females 




174 


Traumatism by machines . . 
White males 


113 
97 




White females 


2 




Colored males 


14 




Colored females 




A175 


Railroad accidents and 
injuries 


4 

644 




White males 


546 




White females 


18 




Colored males 


76 




Colored females 


4 


B175 


Street-car accidents and 
injuries 


75 




White males 


58 




White females 


10 




Colored males 


6 




Colored females 


1 


C175 


Automobile accidents and 
injuries 


176 




White males 


129 




White females 


38 




Colored males 


6 




Colored females 


3 


D175 


Injuries by other vehicles. . 
White males 


110 

88 




White females 


14 




Colored males 


8 




Colored females 











APPENDIX A. 



359 



Condition. Classified by Color^ Sex and by Age Period, 
Mortality Experience, 1911 to 1916. 



Age Periods. 




25 to 
29. 


30 to 
34. 


35 to 
39. 


40 to 
44. 


45 to 
49. 


50 to 
64. 


55 to 
69. 


60 to 
64. 


65 to 
69. 


70 to 
74. 


76 and 
over. 


Infl List 
Number. 


80 


61 


58 


50 


48 


45 


37 


21 


14 


3 




A173 


69 


48 


39 


39 


40 


38 


30 


19 


12 
1 
1 


3 






ii 


13 


19 


11 


"8 


"7 


"7 


2 








3 


6 


6 


3 


5 


6 


3 


2 


2 


1 




B173 


2 


6 


4 
1 
1 


3 


3 


5 


3 


2 


1 








1 






2 


"i 






1 


1 






69 


93 


93 


73 


82 


67 


59 


34 


24 


7 


4 


174 


49 

1 

19 


68 
3 

21 
1 


69 

2 

22 


64 
9 


69 
13 


46 

4 

17 


50 

I 


30 
1 
3 


21 
2 
1 


7 


1 
2 
1 




557 


396 


344 


323 


261 


258 


228 


250 


149 


83 


37 


A175 


471 


312 
17 
60 

7 


279 

9 

50 

6 


251 


210 


195 

28 
33 

2 


181 

20 

25 

2 


187 

39 

21 

3 


117 

17 

11 

4 


67 

13 

3 


24 
7 
3 
3 




13 

67 

6 


14 

49 

9 


13 

33 

5 




101 


74 


101 


93 


105 


121 


130 


110 


85 


53 


46 


B175 


84 

4 

13 


61 
3 
8 
2 


77 
9 

12 
3 


72 
8 

11 
2 


74 

15 

10 

6 


92 

20 

6 

3 


92 
29 

8 

1 


68 

33 

7 

2 


60 

21 

3 

1 


36 
11 

5 
1 


29 

15 

2 




153 


101 


97 


103 


108 


94 


109 


115 


79 


49 


21 


C175 


114 

23 

13 

3 


73 

19 

5 

4 


65 

22 

9 

1 


66 

27 

9 

1 


76 

26 

3 

3 


60 
23 

7 
4 


67 

31 

9 

2 


80 

28 

4 

3 


52 

19 

4 

4 


35 
14 


12 

8 

1 




89 


114 


101 


98 


107 


103 


75 


78 


63 


47 


11 


D175 


79 
3 

7 


87 

9 

17 

1 


80 
4 

15 
2 


74 
7 

15 
2 


75 

14 

16 

2 


76 
10 
17 


60 
6 
9 


59 

8 

11 


46 

10 

6 

1 


29 

13 

4 

1 


9 
1 

1 





360 



MORTALITY STATISTICS OF INSURED WAGE EARNERS. 



Number of Deaths from Each Specified Disela.sb or 
Metropolitan Life Insurance Company Industrial 



Int'l List 
Number. 



Cause of Death. 



Age Periods. 



All 

ages — 1 

jT. and 

over. 



1 to4. 5 to 9. 



10 to 
14. 



15 to 
19. 



20 to 
24. 



E175 



176 



177 



178 



179 



180 



181 



Landslide, other crushing. 



White males. . . . 
White females . . 
Colored males . . 
Colored females. 



Injuries by animals. 



White males. . . . 
White females . . 
Colored males . . 
Colored females. 



Starvation . 



White males .... 
White females . . 
Colored males . . 
Colored females. 



Excessive cold. 



White males. . . . 
White females . . 
Colored males . . 
Colored females. 



Effects of heat . 



White males. . . . 
White females . . 
Colored males. . 
Colored females. 



Lightning . 



White males. . . . 
White females . . 
Colored males . . 
Colored females 



Electricity (lightning 
excepted) 



White males. . . . 
White females . . 
Colored males . . 
Colored females. 



381 

299 
20 

58 
4 

233 

188 
10 
35 



217 

128 
27 
45 
17 

1247 

720 

336 

132 

59 

96 

71 
11 
14 



452 

421 



16 



12 



27 



27 



21 



15 



1 


o 
6 


1 






1 


1 


1 


15 


17 


9 


12 


3 


3 


1 


2 


2 




14 


14 


10 


13 


2 


1 


2 




34 


68 


31 


64 


2 


2 


1 


2 



APPENDIX A. 



361 



Condition. Classified by ColoRj Sex and by Age Period. 
Mortality Experience, 1911 to 1&16. 











Age 


Periods. 


































Infl List 


25 to 


30 to 


35 to 


40 to 


45 to 


50 to 


55 to 


60 to 


65 to 


70 to 


75 and 


Number. 


29. 


34. 


39. 


44. 


49. 


54. 


69. 


64. 


69. 


74. 


over. 




39 


38 


29 


33 


30 


35 


19 


13 


6 


2 


2 


E175 


27 


29 


20 


23 


23 


31 


15 


12 


4 


2 


2 




1 




1 


2 










1 








9 


9 


7 


8 


7 


4 


4 


1 


1 








2 




1 




















11 


15 


19 


20 


16 


14 


13 


10 


16 


6 


2 


176 


7 


14 


16 


15 


14 


12 


11 


8 


14 


5 


2 




1 




1 














1 






3 


1 


2 


6 


2 


2 


2 


2 


2 








3 




1 






3 


3 


2 


1 


2 




177 


1 










1 


1 


2 




1 






1 










2 


1 




1 


1 






1 




1 








1 












13 


22 


14 


16 


20 


23 


22 


24 


18 


13 


5 


178 


5 


15 


9 


6 


15 


12 


16 


18 


9 


5 


1 




2 


2 
3 


5 


4 


1 


2 

8 


2 

4 


1 
4 


4 
3 


2 

4 


3 




3 


5 


3 




3 






1 


1 


1 




1 


2 


2 


1 




41 


70 


122 


104 


120 


128 


130 


107 


125 


101 


66 


179 


25 


44 


81 


71 


82 


82 


68 


54 


69 


36 


26 




3 


14 


13 


18 


17 


27 


40 


39 


43 


56 


32 




10 


8 


21 


10 


14 


14 


15 


10 


10 


7 


4 




3 


4 


7 


5 


7 


5 


7 


4 


3 


2 


4 




13 


8 


5 


5 


6 


4 


5 


1 


2 


1 


1 


180 


10 


6 


3 


3 


4 


3 


3 


1 


1 




1 




2 








1 




1 




1 


1 






1 


2 


2 


2 


1 


1 


1 












66 


49 


45 


33 


14 


12 


11 


3 






1 


181 


63 


46 


41 


30 


12 


11 


8 


3 






1 




1 








1 




1 












1 


2 


4 


2 


1 


1 


2 














1 




1 



















362 



MOKTALITY STATISTICS OF INSURED WAGE EARNERS. 



Number of Deaths from Each Specified Disease or 
Metropolitan Life Insurance Company Industrial 





Cause of Death. 


Age Periods. 


Infl List 
N»unber. 


All 
ages — 1 
yr. and 
over. 


lto4. 


5 to 9. 


10 to 
14. 


15 to 
19. 


20 to 
24. 


185 


Fractures (cause not 

specified) 


806 

414 

316 

57 

19 

1722 

1146 
298 

228 
50 

1149 

1130 

14 

6 

3753 

1148 
500 

1592 
513 

2435 

691 

292 

1132 

320 

616 

167 

43 

297 

109 

702 

290 

165 

163 

84 


12 

8 
4 

176 

96 

72 

8 

3 

1 
2 

28 

10 

16 

2 

8 

3 

4 

1 

5 

2 
3 

15 

5 
9 

1 


27 

16 
9 

2 

160 

87 

52 

15 

6 

3 

2 

1 

45 

19 
15 

7 
4 

16 

9 
4 
2 
1 

5 

1 
2 

2 

24 

9 
9 
6 
1 


20 

15 
3 
2 

123 

84 

26 

11 

2 

2 

2 

60 

24 

16 

15 

5 

37 

15 
7 

12 
3 

7 

3 
1 
2 
1 

16 

6 

8 
1 

1 


14 

12 

2 

144 

112 

7 

22 

3 

156 

155 

1 

352 

119 

58 

127 

48 

238 

83 
42 
92 
21 

60 

20 

3 

22 

15 

54 

16 
13 
13 
12 


20 




White males 


16 




White females 


1 




Colored males 


3 








186 


Other external violence. . . . 
White males 


123 

98 




White females . 


12 




Colored males 


10 




Colored females 


3 


(x-186) 


War deaths* 


431 




429 




White females 


1 




Colored males 


1 




Colored females 




182 to 184 


Homicide (total) 


682 




White males 


184 




White females 


93 




Colored males 


291 




Colored females 


114 


182 


Homicide by firearms 

White males 


459 
125 




White females 


62 




Colored males 


207 




Colored females 


75 


183 


Homicide by cutting or 
pierciag instruments 

White males 


125 
33 




White females '. 


4 




Colored males 


62 




Colored females 


26 


184 


Homicide by other means. . 
White males 


98 
26 




White females 


37 




Colored males 


22 




Colored females 


13 



Includes the two years 1&15 and 1916 only. 



APPENDIX A. 



363 



Condition. Classified by OoloRj Skx and by Age Period. 
Mortality Experience, 1911 to 1916. 



Age Periods. 


























Infl List 


25 to 


30 to 


35 to 


40 to 


45 to 


60 to 


55 to 


60 to 


65 to 


70 to 


75 and 


Number. 


29. 


34. 


39. 


44. 


49. 


54. 


59. 


64. 


69. 


74. 


over. 




36 


36 


47 


57 


50 


54 


68 


91 


90 


118 


76 


185 


28 


25 


36 


39 


38 


35 


31 


41 


24 


37 


13 






5 


6 


6 


8 


14 


23 


42 


60 


75 


60 




6 


6 


5 


11 


3 


3 


3 


5 


2 


5 


1 




2 






1 


1 


2 


1 


3 


4 


1 


2 




115 


118 


97 


104 


117 


108 


108 


74 


75 


44 


36 


186 


78 


78 


66 


67 


86 


75 


79 


50 


46 


29 


15 




9 


11 


5 


6 


8 


17 


17 


12 


17 


10 


17 




20 


25 


22 


26 


20 


14 


11 


10 


9 


3 


2 




8 


4 


4 


5 


3 


2 


1 


2 


3 


2 


2 




200 


170 


100 


62 


14 


5 


1 


1 


1 






(x-186) 


194 


168 


99 


60 


14 


3 


1 


1 


1 








5 


2 


1 


1 




1 














1 






1 




1 














747 


605 


420 


292 


196 


140 


89 


63 


29 


8 


7 


182 to 184 


196 


152 


113 


95 


75 


66 


50 


26 


15 


4 






75 


61 


46 


43 


22 


24 


10 


11 


4 


4 


"2 




362 


289 


212 


121 


83 


40 


22 


10 


8 




3 




114 


103 


49 


33 


16 


10 


7 


6 


2 




2 




539 


405 


277 


190 


114 


69 


45 


21 


10 


3 


4 


182 


135 


100 


64 


58 


34 


26 


25 


10 


3 


1 






49 


34 


27 


28 


16 


15 


3 


6 


2 


2 


1 




272 


204 


160 


83 


65 


22 


13 


2 


6 




2 




83 


67 


26 


21 


9 


6 


4 


3 






1 




121 


98 


67 


52 


29 


16 


17 


8 


3 


2 


1 


183 


36 


17 


21 


10 


7 


6 


8 




2 


1 






2 


6 


5 


7 


3 


2 


4 






1 






65 


66 


29 


28 


15 


7 


4 


5 


1 


_ 


1 




18 


19 


12 


7 


4 


1 


1 


3 










87 


102 


76 


50 


53 


55 


27 


24 


16 


3 


2 


184 


25 


35 


28 


27 


34 


34 


17 


16 


10 


2 






24 


21 


14 


8 


3 


7 


3 


5 


2 


1 


1 




25 


29 


23 


10 


13 


11 


6 


3 


2 








13 


17 


11 


6 


3 


3 


2 




2 




1 



t Does not include war deaths (1,149). 



364 



MORTALITY STATISTICS OF INSUEED WAGE EARNERS, 



Number of Deaths from Each Specified Disease or 
Metropolitan Life Insurance Company Industrial 





Cause of Death. 






Age Periods. 






Infl List 
Number. 


AU 

ages — 1 

yr. and 

over. 


lto4. 


5 to 9. 


10 to 
14. 


15 to 
19. 


20 to 
24. 


187 to 189 


XIV. Ill-Defined 

Diseases 


5448 

2591 

1504 

731 

622 


404 

173 

132 

59 

40 


90 

35 
31 
11 
13 


71 

30 

23 

12 

6 


109 

40 
35 
17 


215 




White males 


72 




White females 


60 




Colored males 


40 




Colored females 


43 




Ill-defined organic disease 

White males 




187 


261 

46 
69 
64 

82 

131 

59 
54 

7 
11 

5056 

2486 

1381 

660 

529 


5 

1 
2 
2 

1 
1 

398 

171 

130 

57 

40 


4 

1 

1 
2 

86 

34 
31 
10 
11 


5 

2 
2 
1 

2 

2 

64 

28 

19 

11 

6 


6 

4 
1 

1 

2 
2 

101 

38 
31 
16 
16 


6 




White females 






Colored males 


2 




Colored females 


4 


188 


Sudden death 


3 




White males 






White females 


2 




Colored males 






Colored females 


1 


189 


Not specified or ill-defined 

White males 


206 

72 




White females 


58 




Colored males 


38 




Colored females 


38 









APPENDIX A. 



365 



Condition. Classified by ColoBj Sex and by Age Period. 
Mortality Experience, 1911 to 1916. 



Age Periods. | 








■ 


















Int'l List 


25 to 


30 to 


35 to 


40 to 


45 to 


50 to 


55 to 


60 to 


65 to 


70 to 


75 and 


Number. 


29. 


34. 


39. 


44. 


49. 


54. 


59. 


64. 


69. 


74. 


over. 




307 


406 


483 


450 


465 


466 


493 


538 


470 


323 


158 


187 to 189 


151 


210 


264 


242 


263 


238 


237 


239 


200 


130 


67 




72 


65 


88 


100 


105 


106 


131 


175 


191 


128 


62 




52 


86 


64 


63 


56 


69 


55 


62 


39 


31 


15 




32 


45 


67 


45 


41 


53 


70 


62 


40 


34 


14 




3 


9 


16 


15 


20 


26 


35 


44 


26 


27 


14 


187 




1 


4 


2 


3 


2 


8 


7 


7 


5 


3 




1 




3 


4 


6 


8 


7 


11 


9 


7 


5 






3 


2 


3 


6 


9 


9 


8 


7 


8 


2 




2 


6 


7 


6 


5 


7 


11 


18 


3 


7 


4 




4 


3 


8 


5 


14 


15 


22 


17 


20 


13 


2 


188 


2 


1 




2 


7 


7 


11 


6 


9 


9 


2 




2 


1 


4 
2 


1 
2 


6 
1 


6 


9 


10 


7 
2 


4 








1 


2 




... 


"2 


2 


1 


2 








300 


394 


459 


430 


431 


425 


436 


477 


424 


283 


142 


189 


149 


208 


260 


238 


253 


229 


218 


226 


184 


116 


62 




69 


64 


81 


95 


93 


92 


115 


154 


175 


117 


57 




52 


83 


60 


58 


49 


6C 


46 


54 


30 


23 


13 




30 


39 


58 


39 


36 


44 


57 


43 


35 


27 


10 





366 



MORTALITY STATISTICS OF INSUEED WAGE EAENEKS. 






H 







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t^ i-HcoaiOJ05c>oi03i-H ooi-HiH (MO500 


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1— ( 


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tH 


a 


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r-t 




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Ti 


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W 














































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£3 




m 


















p 


1 


















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1 




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o 
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02 
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si t 

o = 

a c 

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S3 

1 

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, 4 
"a 


1 


Whooping coug 
Diphtheria and 
Influenza 


1 
J 

1 


Asiatic cholera. 
Cholera nostras 
Dvsenterv. . . . 


5 
5 


1 

J 

•a 
> 


c 

a. 


a 
'S 


1 

'ft 

o 




+2 


05 


03 








00 


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1 



APPENDIX B. 



367 







lOH— •)— MOOtHcq-l— cq(NCX50505iOC<500MT)<iN ocot^ 


IN r)* OOl 




^ 


d 'rn'cO Tt'od'^lioOCOrHrHCqrH'co' OOffqiO OOCOlOl 




Oi 




(N 00 i-H CD <N rH 


i 






(N rH 




1-1 -i--f-rH 05 -1— 00 -i-o; o 05 oa CO o cq 00 05 >* fh -^ co t- w 03 oi 00 i 


(N 


c^ 


1-1 IM (MOOIMOSCOrHrHrt 00 0(Nt^ t^'^CO 


o 


05 




^ 1^ .-H l> (N .-< 


1 


^ 




N 1-1 




(N-i— r-Hcqoo-i— coitvt^c^osiNt^ppcocooeo lo cc imooo] 


M 


IM 


1-1 f0COrt<(N00cOt-ii-iiM CD OiNCO 00>OCD 


Ol 




O l> rH O IM 1-1 


o 






' <N ^ 


• 


OC 


-i-(Np-i-co iopc<ji>iooofot>coiNoqTij QOioco -^.oo-* 


o 


■* 


^ 


"rH Ui Ti3TJHrH0dli3rHrHrH'"oi' OJlNCO OO-^CO 




05 




O t- 1-1 CD (N 1-1 


o 

i 






(N .-( 




l>-i-^T-!Ci5 |l>-l-00e01>(N(N«>O5«5f0'*-*-* pesos t>;P(N| 


la 


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s 


o 




05 CO rH rt 1^ eq rt 


c3 






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to 


^. 


rH CO dlNOodiOrn'rH ■■,-;■ OC^CO OOrfJcO 


s 


OS 




0> CO rH T-l t> <N rH 


Q 


f-H 




rH 7-t 


o 


0-1— "-HiNir^H— co-1— i-jppppprHoqiCfot^-^ piooo coi>i>| 




*" to 


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i-t -^ lOCOrHOOiarHrHi-l 00 OINO OQi^CD 




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05 -H 




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t> 


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03 IN'*! t^ OJOiOO-^^OSiOt^iMffli-i O500O COTjfiOl 




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r- 


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1> Tfl rH IC IN rH 




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t^ lO C<3 0300<ffllO-*0003Tt<t-.00«5«l t>(MCO TftlNCDl 




^~* 


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rH (N TtlCOOt^lClrH rH CD t>ININ COlNlQ 




2 




l^ Tfl rH lO IN rH 




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rHCOrHI>lNO 050INC00005i-IOt>01000 Ot^i* rHt^Ol 




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INIO 05 t^CDCOI>CO-*0>l><NiN(N(N COTf<CO rHOOO 






rH (N OJrHOOlOrH i-l lO rHININ t^C0«O 




0) 




t^ lO rH CO IN rH 


oj 






'"' '"' 




CC 


iNOcococq co(N03iNOiOrHt~t>aicoi> Tt<t^QO ^-coo 







CC 


lNt> OI rH03COOrHCD(NlOINrHOCO lO(N(N t^t^OS 


^ 




I-H ■* OSOOOOlOrHrHi-H 03 tXiN"^ 1>C0»0 


«H 


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00 CO rH CO IN rH 


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rH 7-> 




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rHt^t>.T(< OlNlNOi+IOt^-^lOTtHOOrHrHi* C0»00 l>COOi 


d 


la 


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IN »C iNCOfOOlOCOXiCIN-ttiOCO lOiNO COiTSOi 


3 




■rH CO rHC0Ot>.lClrH rH ,-1 OOlNlO OO'^CO 


^ 


OS 




03 CD rH rH CO IN 1-1 






<-< T-i 




cc 


ICOt^OOCOOO COOOiNCOiOI>OiOC0003rH OOOtH CDOOiO 




to 


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05 




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rH ^ 


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eocor^tj<o-<tio-^coooi:^io«ocoa>t^-<*iaio cocooo (MimoiI 




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oc 


INOOOlrHrH CO(MOO-#lOCOt^>OlOt^»00 COlOlO OOOOt^ 




c 


00 CO COlOCOCOrHOOlOO>INrHCO(N CDCOrH i^OOlO 




rt 05 




IN OC0CD-*C0 1* t^rHTt* rt*I>CO 




05-H 




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fl . 

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5 
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a 

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a 

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p: 




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a 
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p 


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1-1 6 


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iN(NiN(NiNiN<N iNiNcoeoeococococococo eo'i*-* -"a*-* 




i^ 







































368 MORTALITY STATISTICS OF INSURED WAGE EARNERS. 



» 






< 






H 






>^ 






w 






u 






<1 






w 


W 






H 




^ 


^ 




o 
< 


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t>: 


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t>; 


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05 




■ to 1-5 CO i-I ' 1-5 CO ' ic ' 








d 


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a, 








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r-H 




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1-4 


05 




io»cco"'~'05coco-^c^oqc<jTjj Tjj 
'di-J coi-!"r-5c«D'ui" 








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03 




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1-1 


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J> 


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1-1 








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lO00rHTtlrHO5rHt> (NO 








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t- 




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t-H 








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05 








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Tfi 






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1—i 








05 




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05i>icio»oc<ioot>.i>iMrH05 coun 








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C0t>05 rHrH(Mi^OI>COCO (N 








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CO 




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05 




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lCl05Mt^00r^-*rHrHlClrHO iMrfl 








lo 


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1 



APPENDIX B. 



369 





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X 


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lo q 




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CD to CO CD to to CD 


CO to 


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3 


t^ t^ t^ X 




d 





































370 



MORTALITY STATISTICS OF INSURED WAGE EARNERS, 



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■* 


rHTlJINCOOSrH. (Nl> 


m; -* CO IN 




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1 



APPENDIX B. 



371 





, 


00 


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o 


cc 


cc 


O CO ■* Ol rH 


^ 


01IMt^lCir>.IMC0CDTHTl4rHrH|> 


CO 




«2 


00 


^ 


O lO IM lO iM 


QC 


OOrHlO-^lOCOOCOrHC00100I> 


rH 




CO 




<N rH rH rH Ol 


CC 


Tfl COCOrHOC^ OlOrH 


O 




^ OS 




c- 


^ IM ■* 


CC 


t^ COlMCOrH OOrHIM 


1-i 




OS rl 




Tt 














1 * 

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>s 






m 












i; 

ft ■ 




1 
Q 


.J5 _ra 

m O 

o 
O (U 


Q 

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a 

c3 
73 


a; 

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03 
tr-( 
O 




jr 


4 


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1 
73 


e 
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a 


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a 
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m "^ 


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g ftS s s-g 

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o o O^ « ^^ 

03 o3 ^ tj Jr! 1- > 
m (D aj 4} o h " 
CO CO m o rC o3 OQ 

PQQPOQ 


<0 

73 


o3 (h ""^ 


"S i» °^ 5 .2 — < 05 "c 


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^03 aj o -H Tl 

03 > -s ^ -2 

■lull 


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llllllll 

h3o«JiWomoP 


1 : 
ft . 

ft §3 
S ft 




a 


00 


00 

rH 


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lO COt^OOOlOlOrHIMCOTfllOCC 


i> 




3d 


05 


l-H 


Ol o o o o 


o 


O O O O O O rH tH rH rH rH rH r- 






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1 


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r^ '^ 



S h:i 



372 



MOETALITY STATISTICS OF INSURED WAGE EARNERS. 






<? 9 



C4 




B 

o 


« 


S 


O 


OQ 


H 












ij 


CO 


Ct< 


hH 


PI 


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cT 


ft 


«l-l 


H 




J 


w 


w 




o 


W 


P 


Ph 


H 


rt 


M 




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H 


R 









b- 


•* 


O: 


q 1 


N. CO CO IC CO 




rH 






10 o 


q 


1 




^ 




ei 


,-; lO 1 r-i ■ r-i " (N 








" (N IN 


rH 




(3 




(M 


^ OS 1 












i 






i-( 
















"3 


CO 


ic •* 00 t^ iq ■* ■<J< 




tH 




rH 00 "5 


00 


ej 




■* 


d oi -H ■ ,-H ■ IN 








' IN rH 




ts 


a 




(N 


05 
































t>. 


to 


O O 1 CD CO ^ lO O- 




c: 




rH CO O 


o 


a 
o 


n 




d 


d d r-i ■ r4 ■ ^ 








' (N rH 


rH 


S 




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-< 03 












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IN lO (N 


rH 


§ 


If! 




00 


CO lO rH ■ rH ■ IN 








■ IN rH 


rH 


o 


o> 






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u 


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03 


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1- 




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q 


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05 








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i 


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l> 


looq-f— cocoi-H-^(N 




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d 


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rt 03 




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05 05 


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^ 




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lO 




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IQ 


CO 


C^ Ol 


CO ■^ O CO t^i 








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t^ 




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m 


05 CO 










1— 1 rH 








a> 


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X 




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ss 




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(D 




03 




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IN rH 








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X 
















1 




y—i 
















1> 


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t^ lO CO »0 05 •* cc 








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IN 


03 OS 1— 1 1-1 lo CO c<; 




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■<(! 


10 


<0 


X rH ■* CO ^ CO cc 








rH (N tH 


o 






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o 
1 


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o 


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1> 


CO 


iNCOi-i MXXOSO 


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rH 





lO 


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o> 


CO lO Tf ■<* OS IN 1> 








rH IN O 


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3 




CO 


X (N —1 r^ 






IN rH 




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1-1 
1-1 


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Ic 




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o 




«5 


ir: 


M 


X t^ CO "3 t^ CO — 








rH CO IN 


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CO 


X O 1-1 (M 








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s 




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o 


















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Ttl 


a> 


OIVCO i-ilNr^(N!N 




Ic 




O IC CO 


29 




CD 


c 




IN CO CO (N rH O CD 


": 




CO CO X 


o 




cc 


CT> 


r-l O X CO CD IN 1- 








CO t^ 


U5 




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T-t 






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CD 


lO 














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1 

m 
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H « J 

5 <J ^ 

■»* >• PS 






.-o 

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a 

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1 

£ 




3 

a 

o 
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1 

1 
1 




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a 

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CO 

T-l 
















s 


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t^ 




X 


05 O 


rH 




ji 




3 


rHINININ (NININ(M 


IN 




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r-l 


























' 



APPENDIX B. 



373 



1 




U5 


•)- 00 


l> -* CO 00 l>; 


(>. rH -1— 


o 


IN 00 CO 


"? 




03 


CO 




05 


rH ^ (N 00 •<<< 




CO 


IN 




•a 


















r-J 


^ -* 


IC rJJ O O 00 


<q ^ 


CO 


CO H* 0> 


■O 


V 


^ 


e>3 




00 


^ ^' <N 00 ^^ 




CO 


1-5 




o 


o> 


















o 


'^ 




















CO 


■*~ '^ 


I> CO O •-< CO 


lO r-J 


IN 


CO tH CO 


CO 


iH 


CO 




o 


I-H r-H Oi Oi "5 




00 


rA ' ' 




a> 






(N 














1^ 


















& 






















CO 


,-J 00 


t>; l> O) •* -1 


05 >-;■<— 


50 


O TjJ CO 


to 


^ 


CO 




05 


r-H ^ ^ 00 UJ 




IN 


rH 




1 


s 






^ 












a 






















lO 


^. p 


00 O l> (N 00 


00 >-;■«- 


IN 


00 ^ CO 


"^ 


U3 


CO 




00 


^ ^ -i |> Tli 




oi 






d 

« 

^ 


«» 






" 














1-1 


■*" ^ 


•rh rl< 00 C^ O 


i> .-; 


'^ 


t>; «0 00 


"^ 


rt 


to 


CO 




b- 


^ .-H --J l> id 




(N 






S 


OS 






i-H 












fi 


'^ 


















°» 


CO 


rH 05 


O lO 05 I-H O 


^ rH 1— 


X 


CO ■* r^ 


>c 




CO 


CO* 




00 


rH rH -H 00 id 




(N 


r-J 






11 OS 






»-H 














OS It 










































■* 


lo (M 


CO S^ 05 t^ o 


CO CO c^ 


CO 


iC lO ■^ 


05 




y-t 


t^ 




-* 


CO — 1 t- 00 t- 


>o 


X 


«> IN ■* 


CO 




OS 


M 




uo 


^ rH ^ O CO 




c» 










to 


00 o 1 


CO t> CO rti t- 


t^ CO 




00 


rH O O 


"ca 




IN 


lO 




I-H 


CQ .-H CO »o Ol 


■* 




J> 


CO CO l> 


•* 






iM 




lO 


^ ^ rt CO CO 






M 








Oi 






1-1 
















05 


"^ 00 1 


05 O 00 CO 00 


CO t^ 


IN 


rH U5 CO 


CO 




CO 


X 




CO 


-!*< -H O 05 lO 


'^ 


X 


■^ 00 >o 


kO 




(M 




(^ 


^ ,-H rt t> rj< 




(N 








OS 






T-H 












1 






















^ 


Oi CO 1 


Ol O CO 00 «o 


03 lO tH 


rH 


rH CO X 


05 





>* 


O 




CO 


lO CO 1> I> N, 


l> 


'Jt^ 


0> CO lO 


«Q 


CO 




00 


,-H ,-1 ^ !> -^ 




c^ 






o 


OS 




















03 

CO 


"o I—* 1 




05 05 iH 


o 


lO O X 

t^ ^^ o 


00 


s 


lO 


rt Th 1 


t^ lO CO Ol CO 


I> 


s 


CO 




t^ 


— 1 rH T-H CO -* 




IN 






;z; 


OS 




















o 


lo" t- 1 


TjH 00 03 O .-H 


00 o 


o 


X IN t^ 


CO 




CD 


(N 




00 


-* CO l> CO -H 


CD rH 


^ 


CO lO t^ 


■* 




CO 




t> 


^ _ ,.H t- lO 




IN 








OS 






I-H 


































o 


(N 


T^ -H 1 


lO oH CO 00 lO 


05 CO "^ 


Oi 


rH lO O 


00 




^i 


00 


CO lO 1 


00 05 CO •* t^ 


CO TJH 


IN 


X rH CO 


t- 




o 




T-H 


00 t> O CO CO 


CO 


to 


CO IN CO 


IN 




rt OS 


.-1 




o 


^ Tt< <M 




J-l 








OS rt 




















^ 






















s • "^ 












03 


a 






a 








"H 










03 j3 

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a) ^ ^ 




H 








^ 


CD 






z ■ 

















i 

a 

o 




1 

a 
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>> 

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as 
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'a 


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03 


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«< 1-3 






a 


"o 

m 

33 








o 


■ail 


* 

a 

a 

J2 




ai -1 o -:- -3 -H 

-+J OT o '^ ^ ?3 
g 03 '^ fe fe O 

o <si ^ <u o <a 
o 3 +3 3 3 a 


O 0) 
-O 73 


.all 

5 53 ^ 

O -S tH 
So® 
O ° 3 


So 


aj C3 ^ 
M S "^ *H 


i 










<! Ph O PU PL( PM 


fe fin 




OfiH<10 












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■* 






Tt* 








Q 


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r}( la CO 1> 00 03 


O rH 




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o 


CO CO CO CO CO CO 


^ rp 


2 


^ ■* •* ■* 






^ o 


i-H 1-1 




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r-t rH 


^-t T-^ r-t r^ 






a 






■* 






C<1 








H 






CO 






■* 
































rl 












1 



374 MOKTALITY STATISTICS OF INSUEED WAGE EAENEES. 



O 



5 ^ 



f» fi 



H 


f^ 


h-l 


f^ 


m 


w 


^ 


tu 


H 


M 




N 



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P . 

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rH 


00 IN H- 


-1- 


CO 


CO 


(N 


IN 


05 


CO TjH N. lO CD O 


t^ 






•^ 




<N 


i-H 






00 


00 


l> 


CO IC rH rH ' CO 








a> 
















Oi 


1-1 






. 


^ 




























CO 


q INH- -H- 


to 


CD 


lO 


"? 


05 


•^ X t^ ■* CD 05 


CO 




IN 




(N 


<N 




' 


t>^ 


t-i 


IN 


(N Tl5 rH r-i 'in 






s 


Ol 
















OS 


rH 








■^ 




























(N 


O IN 1 -1- «0 


"? 


rH 


r-* 


CO 


lO rH rH «Cl t>- rH 


b; 




d 


CO 




(N 


N ■ 1 






l> 


t> 


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CO IC IN rH ■ CO 






0) 


C5 
















05 


i-i 






P^ 
























o 






lO 


(N IN tH 


CO 


CO 


(N 


IN 


(N 


CO 00 05 >0 lO l> 


CO 




o 

o 


■* 




e4 


IN 




" 


CO 


CD 


Cft 


M ^' rH rH ' IN 






o 

o 


OS 
















00 


t-l 




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IN CO 4- -H 


t>; 


b. 


CO 


CD 


IN 


IN 00 CO lO J> 00 


CO 


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IN 


IN 






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00 


IN CO IN rH "in 

rH 




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o3 


























9 






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i-H CO 1-J 


t> 


J> 


03 


05 


lO 


00 00 05 (N •«*i "3 


CO 


fi 




to 




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■ 




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2 • 




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r-i (N -1- tH 


CO 


CO 


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10 


CO 


(N ■* 05 -^ CO 00 


CO 


CO 




^to 




IN 


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CD 


CD 


-* 


(N Tji rH rH ' (N 




E3 

n3 




S2 

05 iH 
















05 


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PI 




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M 








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lO 


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CD 






J 




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IN 


CO 


CO 


IN 


CO IN CO rH 10 CO 


10 


a 




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CD 


CD 


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05 
















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S 




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Ol 


CO IN 


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rH 


CO 


rH 05 CO rH T^ CO 


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1 










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t^ 


1—4 


00 'i* t^ l> CO 


CO 


03 








05 


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lO 


l> -^ 00 IN iC l> 


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1 


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CO 


pl 









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CD 


CO 


CO 


CD 


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CO Tti l> CO It* ifl 


10 


l-H 


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IN 


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IN 


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h-l 


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IN 






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in 


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iz; 


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10 Ttl CO 00 CO IN 


tH 


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C31 


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05 00 05 rH rt< IC 


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to 


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IN 


IN IN rH CO a 


CO 


1^5 






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O IN OC 


IN 


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OC 


rH 


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IN 




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02 
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CO 


OF THE ' 
LOCOMOTIC 

ses of bones 
ies of joints 

fatinns 


0) 

1 = 

CD ..- 


1 a 
S3 


O 


> 


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c 


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or 

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3 


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lO 


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CO 






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APPENDIX B. 



375 



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376 



MORTALITY STATISTICS OF INSURED WAGE EARNERS. 



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APPENDIX C. 

Effect of System of Inquiry to Physicians upon Death 
Eates of Principal Diseases and Conditions. 

There are two general sources of error in the statistics of causes 
of death. The first source is the inherent inaccuracy and uncer- 
tainty of the diagnoses in a fairly significant proportion of the 
deaths certified. This element of defect in the statistics has been 
found upon recent inquiry, however, not to assume as much im- 
portance for the chief diseases and conditions as was at one time 
thought to be the case. Some committee work on behalf of the 
American Public Health Association by a group of pathologists, 
clinicians and statistical workers, has shown that the statistics of 
the causes of death represented in contemporary American regis- 
tration practice are, for the most part, reliable for the practical 
purposes of public health work, and that they are worth the time, 
effort and expense required for the proper collection, tabulation 
and publication of the same.* This conclusion, based upon the 
deliberations of a representative committee, should go far to off- 
set the suspicions and the doubts as to the accuracy of the statis- 
tics of certified causes of death which have appeared in recent 
vital statistical literature. 

The second important source of error in the statistics of causes 
of death arises from the failure of certifying physicians to report 
all the morbid conditions known to them and which had any bear- 
ing upon the cause of death. Physicians often report only condi- 
tions such as " acute nephritis," " peritonitis," " septicemia " and 
other merely terminal incidents in the course of the last illness. 
This practice is perhaps excusable in view of the fact that the 
terminal condition is uppermost in the physician's mind, probably 
because it required the largest part of the physician's effort on 
behalf of his patient. These incomplete statements of causes of 
death account for a quite significant proportion of the total amount 

* See reprints 363 and 440, from Eeports of the United States Public 
Health Service, 1917 and 1918. "The Accuracy of Certified Causes of 
Death and its Relation to Mortality Statistics and the International List." 

377 



878 



MOKTALITY STATISTICS OF INSURED WAGE EAENERS. 



TABLE 178. 

Effect of System of Inquiry to Physicians upon Death rates of Im- 
portant Diseases and Conditions. 
Number of Deaths before and after Inquiry and Percentage Change in 

Death rate. 
Experience of Metropolitan Life Insurance Company. Industrial Depart- 
ment. 1911 to 1916. 



Inf 1 List 
Number. 



Disease or Condition. 



Number of 


Deatlis. 


Before 


After 


Inquiry. 


Inquiry. 


2280 


806 


5052 


2773 


1725 


1013 


3341 


2224 


6010 


4171 


402 


293 


1091 


797 


6500 


5120 


2148 


1722 


1082 


939 


1239 


1083 


5800 


5279 


45084 


41707 


52260 


52067 


93351 


93526 


13052 


13089 


6518 


6542 


8981 


9035 


13957 


14153 


8882 


9011 


2310 


2352 


1324 


1353 


8899 


9142 


2995 


3075 


4505 


4638 


3054 


3155 


4338 


4482 


4619 


4776 


6118 


6345 


7588 


7882 


2334 


2435 


3418 


3579 


894 


938 


34443 


36638 


1237 


1318 



Percentage, 

Deatlis After 

of Deaths 

Before 

Inquiry. 



185 
66 

117 

67 

B61 

46 

62 
119 
186 
94 
20 
45 

92 

120 

28 

9 

156-163 

29, 32-35 

40 

1 

155 

39 

81 



7 
31 
41 

6 

108 
42 

182 
43 

44 

64 
183-184 



Fractures (cause not specified) 

Paralysis without specified cause 

Simple peritonitis — nonpuerperal 

General paralysis of the insane 

Simple meningitis 

Other tumors (tumors of the female genital 

organs excepted) 

Locomotor ataxia 

Acute nephritis 

Other external violence (excl. war deaths) . . 
Pulmonary congestion, pulmonary apoplexy 

Purulent infection and septicemia 

Cancer and other malignant tumors of other 

organs or of organs not specified 

Pneumonia (lobar and undefined) 

Bright's disease 

Tuberculosis of the lungs 

Diphtheria and croup 

Suicides (except suicide by poison) 

Other forms of tuberculosis 

Cancer and other malignant tumors of the 

stomach 

Typhoid fever 

Suicide by poison 

Cancer and other malignant tumors of the 

buccal cavity 

Diseases of the arteries, atheroma, aneur- 
ism, etc 

Whooping cough 

Scarlet fever 

Abdominal tuberculosis 

Cancer and other malignant tumors of the 

peritonetun, intestines, rectum 

Measles 

Appendicitis and typhlitis 

Cancer and other malignant tumors of the 

female genital organs 

Homicide by firearms 

Cancer and other malignant tumors of the 

breast 

Cancer and other malignant tumors of the 

skin 

Cerebral hemorrhage, apoplexy 

Homicide (except homicide by firearms) . . . 



35.4 
54.9 

58.; 

66.6 
69.4 

72.9 
73.1 

78.8 
80.2 
86.8 
87.4 

91.0 
92.5 
99.6 
100.2 
100.3 
100.4 
100.6 

101.4 
101.5 
101.8 

102.2 

102.7 
102.7 
103.0 
103.3 

103.3 
103.4 
103.7 

103.9 
104.3 

104.7 

104.9 
106.4 
106.5 



APPENDIX C. 



379 



TABLE 178 (Continued). 



Int'I List 
Number. 



Disease or Condition. 



Number of 


Deaths. 


Before 


After 


Inquiry. 


Inquiry. 


15126 


16224 


1945 


2160 


7247 


8056 


4129 


4647 


629 


743 


2124 


2555 


5558 


6917 


2345 


4659 


83 


200 


290 


823 



Percentage, 

Deaths After 

of Deaths 

Before 

Inquiry. 



91 

B63 

10 

30 

51 

56 

172 

37 

38 

A61 



Bronchopneumonia 

Other diseases of the spinal cord 

Influenza 

Tuberculous meningitis , 

Exophthalmic goitre , 

Alcoholism (acute or chronic) . . . 

Traumatism by fall , 

Syphilis , 

Gonococcus infection 

Cerebrospinal fever 



107.3 
111.1 
111.2 
112.5 
118.1 
120.3 
124.4 
198.7 
241.0 
283.8 



of error in mortality statistics of the several diseases and condi- 
tions. The remedy for the first cause of error lies largely with the 
forces of medical education and diagnostic progress. The amount 
of absolute error due to the second important element of incom- 
plete statement can be quite readily controlled by a system of cor- 
respondence with certifying physicians. By means of such a pro- 
gramme, each certification by a physician which is obviously or 
probably an understatement is subjected to scrutiny and becomes 
the occasion for a letter asking for all the facts as to diseases and 
conditions contributing to the death. 

A plan of this kind was inaugurated at the beginning of the 
present mortality investigation and was carried out in principle, 
with necessary additions in the scope of the inquiries, throughout 
the entire six-year period. In Table 178 on pages 378 and 379, we 
show the effect of this system of correspondence upon the death 
rates of the more important diseases and conditions represented in 
this experience. 

From the foregoing tabulation, it will be seen that as a result 
of correspondence with physicians the number of deaths certified 
as due to "fractures" (cause not specified) was reduced from 
2,280 before inquiry to 806 after inquiry, or a reduction of 64.6 
per cent. Another equally unsatisfactory certification was " paraly- 
sis," without specified cause. The number of such registrations 
in our final tables was reduced from 5,052, the number which was 
originally reported by physicians, to 2,773, after inquiry, or a re- 
duetion of 45.1 per cent. Inspection of the table will show other 
important alterations in the death rates of certain causes of death, 



380 MORTALITY STATISTICS OP INSURED WAGE EARNERS. 

the reduction being due solely to the persistent scrutiny of death 
certificates for incomplete statements, and the subsequent effort to 
secure complete and satisfactory reports from the physicians. A 
number of causes of death such as Bright's disease, tuberculosis 
of the lungs, diphtheria and croup, cancer of the stomach, and 
typhoid fever were affected, so far as their death rates were con- 
cerned, only to a very limited extent by this system of inquiry. 
Certain other causes of death such as whooping cough, scarlet fever 
and cancer of the peritoneum, intestines and rectum, which one 
might expect to be affected by masked returns of "broncho- 
pneumonia," "acute nephritis" and "peritonitis," respectively, 
show sbmewhat greater percentages of alteration in the recorded 
death rates. Cerebral hemorrhage and apoplexy, influenza, alcohol- 
ism, traumatism by fall, syphilis, gonococcus infection and cerebro- 
spinal fever were quite emphatically influenced in their death rate^ 
by this programme of correspondence with certifying physicians. 

The table on pages 381 to 384 shows what disposition was made 
of certain of the terms originally certified under obviously incom- 
plete statements. 

Thus, out of 295 "purulent infection and septicemia," replies 
received, most of which were originally returned as " septicemia," 
76 cases or 25.8 per cent, were finally classified in our statistics as 
" puerperal septicemia." Cancer cases, where the organ or part 
was not specified by the physician, in 223 cases, or 25.3 per cent., 
out of an original total of 883 replies, were subsequently registered 
as "cancer of the female genital organs," and 126 cases, or 14.3 
per cent., as " cancer of the breast." 

Returns of " meningitis " were found to have been due to tuber- 
culous meningitis in 17.1 per cent, of the cases and to cerebrospinal 
fever in 19.1 per cent, of the total number of replies received. 
Terminal cardiac states such as "acute cardiac dilatation" and 
"cardiac insufficiency" were found to have been pneumonia cases 
in 11.9 per cent, of the replies received. "Peritonitis" without 
further definition was finally registered as " appendicitis " in 17.3 
per cent, of the cases and as " puerperal septicemia " in 14 per cent. 

The statistics of accidental, homicidal and suicidal violence were 
affected in an important degree by the clearing up process applied 
to cases which were simply certified as " fractures." Out of 1,637 
fracture eases, 1,011, or 61.8 per cent, of the total number, were 



APPENDIX C. 



381 



TABLE 179. 

Number op Deaths where the Causes of Death were Originally Speci- 
fied IN Ill-defined Terms, showing also the Number and Per- 
centage OF SUCH Deaths Definitely Certified after 
Inquiry to Physicians. 

Experience of Metropolitan Life Insurance Company. Industrial Depart- 
ment. 1911 to 1916. 



Ill-defined Term Reported 
Belore Inquiry to Physician. 



Purulent infection and 

septicemia 
Total replies — 295 

Unchanged by inquiry : 
88 or 29.8 percent. 



Cancer and other ma- 
lignant tumors of 
other organs, or of or- 
gans not specified 

Total replies — 883 
Unchanged by inquiry : 
246 or 27.9 percent. 



Meningitis 
Total replies — 2560 
Unchanged by inquiry: 
701 or 27.4 percent. 



Locomotor ataxia 
Total replies — 596 
Unchanged by inquiry : 
294 or 49.3 percent. 



Paralysis without speci- 
fied cause 

Total replies — 2598 
Unchanged by inquiry : 
302 or 11.6 percent. 



Cause of Death Ascertained by Inquiry to 
Physician. 



I Changes In State- 

I ment ol Cause 

of Death. 



Total changes from "purulent infection 
and septicemia" to cause of death 
specified below 



"Other diseases of the uterus" . 

Puerperal septicemia 

Acute abscess 

Other titles 



Total changes from ' ' cancer . . . , organs 
not specified" to cause of death speci- 
fied below 



Cancer. . .of the buccal cavity 

Cancer ... of the stomach 

Cancer. . .of the peritoneum, intestines, 

rectum 

Cancer . 
Cancer . 
Cancer . 



.of the female genital organs. 

. of the breast 

. of the skin 



Other titles . 



Num- 
ber. 



Tuberculous meningitis 

Cerebrospinal fever 

Pneumonia — ^lobar and undefined 

Diarrhea and enteritis — 2 years and over 
Other titles 



Total changes from ' ' locomotor ataxia ' 
to cause of death specified below 

Syphilis 

Other titles 



Total changes from "paralysis without 
specified cause" to cause of death 
specified below 

"Other diseases of the spinal cord" . . . . 

Cerebral hemorrhage, apoplexy 

General paralysis of the insane 

Other titles 



207 70.2 



76 

9 

114 



637 



27 
113 

100 

223 

126 

42 



Total changes from "meningitis" to 
cause of death specified below 1859 



439 

489 

108 

94 

729 



302 



282 
20 



2296 



2.7 

25.8 

3.1 

38.6 



72.1 



3.1 

12.8 

11.3 
25.3 
14.3 

4.8 

.7 



72.6 



17.1 
19.1 

4.2 

3.7 

28.5 



50.7 



47.3 
3.4 



88.4 



322 


12.4 


1613 


62.1 


149 


5.7 


212 


8.2 



382 



MOETALITT STATISTICS OF INSURED WAGE EAKNEES. 



TABLE 179 (Continued). 



lU-deflned Term Reported 
Before Inquiry to Physician. 



Cause of Death Ascertained by Inquiry to 
Physician. 



Changes In State- 
ment of Cause 
of Death. 



Num- Percent- 
ber. age. 



General paralysis of the 

insane 
Total replies — 2076 

Unchanged by inquiry 
761 or 36.7 percent. 



Organic diseases of the 

heart* 
Total replies — 1175 

Unchanged by inquiry: 
697 or 59.3 percent. 

Diseases of the arteries, 
atheroma, aneurism, 
etc.f 

Total replies — Q53 
Unchanged by inquiry : 
493 or 51.7 percent. 



Pneumonia 
Total replies — 5493 
Unchanged by inquiry: 
1595 or 29.0 percent. 



Pulmonary congestion, 
pulmonary apoplexy 

Total replies — 245 
Unchanged by inquiry: 
84 or 34.3 percent. 



Peritonitis — non-puer- 
peral 

Total replies — 901 
Unchanged by inquiry: 
179 or 19.9 percent. 



Total changes from "general paralysis 
of the insane" to cause of death 
specified below 

Syphilis 

Other titles 



Total changes from "organic diseases of 
the heart" to cause of death specified 
below 



Cerebral hemorrhage, apoplexy. . . 
Pneumonia — ^lobar and undefined. 
Other titles 



Total changes from "diseases of arteries, 
etc." to cause of death specified below 

Syphilis , 

Cerebral hemorrhage, apoplexy , 

Other titles , 



Total changes from "pneumonia' 
cause of death specified below. . . . 

Influenza 

Bronchopneumonia 

Lobar pneumonia 

Other titles 



to 



Total changes from "pulmonary conges- 
tion, pulmonary apoplexy" to cause of 
death specified below 

Organic diseases of the heart 

Chronic bronchitis 

Pneumonia — lobar and undefined 

Bright's disease 

Other titles 



Total changes from "peritonitis" to 
cause of death specified below 

Abdominal tuberculosis 

Diarrhea and enteritis — 2 years and over 

Appendicitis and typhlitis 

Salpingitis and other diseases of the fe- 
male genital organs 

Puerperal septicemia 

Other titles 



1315 



1257 
58 



478 



140 
252 



460 



175 
172 
113 



3898 



529 
1076 
1692 

601 



161 



32 
8 
16 
11 
94 



722 



69 

33 

156 

76 
126 
262 



* Most of the terms included under the title ' ' organic diseases of the 
heart" are fairly definite. However, certain expressions such as "acute 
cardiac dilatation ' ' and ' ' cardiac insufficiency ' ' are often reported when 
they are only terminal symptoms of other diseases. It is these expressions 
which are covered by our inquiry. 

t Practically all of the inquiries related to reports of ' ' aneurism, ' ' 



APPENDIX C. 



383 



TABLE 179 (Continued). 



lU-deflned Term Reported 
Belore Inquiry to Physician. 



Causa oj Deatli Ascertained by Inquiry to 
Physician. 



Changes In State- 
ment of Cause 
of Death. 



Num- Percent- 
ber. age. 



Acute nephritis 
Total replies — 3271 
Unchanged by inquiry : 
1852 or 56.6 percent. 



"Other diseases of the 

uterus" 
Total replies — 280 

Unchanged by inquiry: 
85 or 30.4 percent. 



Traumatism by fire- 
arms 

Total replies — 157 
Unchanged by inquiry: 
35 or 22.3 percent. 



Fractures (cause not 

specified) 
Total replies — 1637 

Unchanged by inquiry: 
151 or 9.2 percent. 



"Other external vio- 
lence" 

Total replies — 708 
Unchanged by inquiry : 
132 or 18.6 percent. 



Total changes from "acute nephritis" 

to cause of death specified below 

Scarlet fever 

Influenza 

Alcoholism (acute or chronic) 

Bright's disease , 

Other titles 

Total changes from "other diseases of 
the uterus" to cause of death specified 
below 

Gonococcus infection 

Cancer and other malignant tumors of 
the female genital organs 

Uterine tumor (noncancerous) 

Cysts and other tumors of the ovary . . . 

Salpingitis and other diseases of the fe- 
male genital organs 

Puerperal septicemia 

Other titles 

Total changes from traumatism by fire- 
arms to cause of death specified below . 

Suicide by firearms 

Homicide by firearms 

Other titles 

Total changes from "fractures (cause 
not specified) " to cause of death speci- 
fied below 

Traumatism by fall 

Traumatism by crushing — electric rail- 
way 

Traumatism by crushing — steam rail- 
way 

Traumatism by crushing — automobiles. 

Traumatism by crushing — other vehicles 

Traumatism by other means 

Other titles 

Total changes from "other external 
violence" to cause of death specified 
below 

Purulent infection and septicemia 

Traumatism by fall 

Traumatism by machines 

Traumatism by crushing — steam rail- 
way 

Traumatism by crushing — electric rail- 
way 

Traumatism by crushing — automobiles. 

Traumatism by crushing — other vehicles 

Other titles 



1419 



95 
156 
341 
118 
709 



195 



1486 



1011 



53 



576 



43.4 



2.9 
4.8 

10.4 
3.6 

21.7 



69.6 



23 


8.2 


12 


4.3 


25 


8.9 


6 


2.1 


38 


13.6 


53 


18.9 


38 


13.6 


122 


77.7 


9 


5.7 


110 


70.1 


3 


1.9 



90.8 



61.8 



3.2 



44 


2.7 


61 


3.7 


89 


5.4 


60 


3.7 


168 


10.3 



81.4 



22 


3.1 


218 


30.8 


41 


5.8 


43 


6.1 


21 


3.0 


26 


3.7 


58 


8.2 


147 


20.8 



384 MORTALITY STATISTICS OF INSUEED WAGE BAENBR8. 



TABLE 179 (Continued). 



Ill-defined Term Eeported 


Cause of Death Ascertained by Inquiry to 
Physician. 


Changes In State- 
men t of Cause 
of Death. 




Num- 
ber. 


Percent- 
age. 




Total changes from "ill-defined dis- 
eases" to cause of death specified below 

Malaria 


422 


70.6 


Total replies— 598 


15 

22 
107 

27 
251 


2 5 


Unchanged by inquiTy: ( 


Tuberculosis of the lungs 


3 7 


176 or 29.4 percent. 


Organic diseases of the heart 


17 9 




Bright's disease 


4 5 




Other titles 


42.0 



identified as deaths due to falling; 3.3 per cent, were caused by 
electric railway accidents, 2.7 per cent, by steam railway accidents, 
3.7 per cent, by automobile accidents and 5,4 per cent, by other 
vehicular accidents. " Gunshot wound," in 157 replies, was found 
to have been homicide by firearms in 110 cases, or 70.1 per cent., 
and suicide by firearms in 9 cases, or 5.7 per cent. Original certi- 
fications of " injury," " violent death," and other ill defined terms 
for violence classified under Title 186 of the International List, 
were found to have been made for falls in 30.8 per cent, of the 
cases; in machinery accidents in 5.8 per cent.; in steam railway 
accidents in 6.1 per cent, of the original number of returns. 

From this brief review of an extensive programme for improv- 
ing the validity of the statistics of the causes of death shown in 
this present report, it will be seen that incomplete and understate- 
ment of the morbid conditions contributing to death is highly 
significant to students of the medical statistics of mortality. It is 
evident that some allowance must be made in all published statistics 
of mortality from causes of death, for this factor of possible under 
and incomplete certification of diseases and conditions. The fore- 
going tables and the appended text will show in a measure the 
extent of this specialized problem in medical statistics. It is hoped 
that the value of a systematic programme of inquiry to physicians 
in cases of doubtful certification has been established by the fore- 
going display of the facts for the basic material of this report. 
They supplement the conclusions published in recent Census Bu- 
reau mortality reports under the caption of " Accuracy of Statistics 
of Causes of Death." 



APPENDIX D. 

Standakdized, or Coreected, Death Eates. 

A judgment on the comparative healthfulness of two popula- 
tion or exposure groups, in terms of a single expression, is often 
necessary in the analysis of public health statistics. For instance, 
we may wish to compare, in the aggregate, white males of the in- 
surance experience with males of the Eegistration Area experi- 
ence. No direct comparison of the death rates for the total, ages 
one and over, is valid, however, without proper allowance for dif- 
ferences in the age composition of the two groups. On page 23 
we gave a comparison of the death rates of the insurance andi "popu- 
lation groups, and showed that for all ages one and over, insured 
white males had a crude mortality rate 95.2 per cent, of the rate 
among males in the general population, and that insured white 
females registered a death rate 93.9 per cent, of the rates for 
females in the population of the expanding Eegistration Area of 
the United States. Apparently, there was a more favorable bal- 
ance of mortality for the group of insured wage earners. But in- 
spection of the table on page 5 shows that the average age of the 
insured group is much lower than that of the population exposure. 
A considerable bulk of the insurance white male experience con- 
sists of lives under twenty years of age (50.3 per cent.), as com- 
pared with 36.2 per cent, in the population experience. These dif- 
ferences in age constitution account for the apparently more favor- 
able ratio of mortality in the total white male and white female 
insured groups. 

A convenient means for eliminating the influence of variable 
age constitution is available. The " specific death rates," or death 
rates relating to specific sex and age classes in the two groups to 
be compared, can be multiplied into an assumed " standard popu- 
lation" by sex and age to produce an "expected" number of 
deaths. For this purpose we chose the age groups (for ages one 
and over) of the " standard million of population, England and 
Wales, 1901j" and by multiplying the sex and age death rates of 

385 



386 MOETALITT STATISTICS OF INSURED WAGE EAENEES. 

the insurance and population experiences, respectively, into the 
numbers in each of the corresponding sex and age classes of the 
"standard" or "norm" population, we produced for each experi- 
ence and sex class, an "expected total number of deaths." The 
ratio of the expected number of deaths based upon the rates for 
insured white males to the expected number of deaths for popula- 
tion males, is an accurate measure of the relative healthfulness of 
the two groups, so far as we may determine this fact from the mor- 
tality statistics of the two groups. A tabular display of the results 
of this correction process is given below : 



TABLE 180. 

Expected Number of Deaths, Ages One and Over, in ' ' Standard Million 
OF Population in England and Wales, 1901" According to Specific 
Death Rates op (a) Metropolitan Industrial White Experience, 
1911 to 1916 AND (&) Expanding Eegistration Area Experience, 1910 
TO 1915, BY Sex. 





Expected Number of Deaths In "Stand- 






ard Population," According to Specific 






Death Rates In : 


Percentage, M. L. I. 


Sex. 






Co. of Reg. Area 




M. L. I. Co. White 


Reg. Area (U. S.) 


Expected Deaths. 




Experience, 1911 


Experience, 1910 






to 1916. 


to 1915. 




Males 


7,107 
6,264 


5,561 


127.8 


Females 


5,602 


111.8 







From the foregoing table we may conclude that the total mor- 
tality of insured white male wage earners is in reality 28 per cent, 
higher than mortality among males in the general population and 
that the group of insured white females shows an excess of 12 per 
cent, in mortality. 

If the numbers of expected deaths in the foregoing table are 
divided by the total corresponding "standard population" at ages 
one and over the following "corrected" death rates are produced. 
A comparison with the crude rates is shown in the table on page 
387, together with the standardization or correction factor. 

In other words, the process of correction produces an increase 
of 27.7 per cent, in the death rate for insured white males, of 19. o 
per cent, in the death rate of insured white females, a decrease of 
4.8 per cent., and an increase of .3 per cent, in the death rates 
of males and females, respectively, in the general population. 



APPENDIX D. 



387 



TABLE 181. 
Crude and Standahdized Death rates pee 1,000, all Causes of Death, 

compaeed. 
Standardization factor: (Eatio of Standardized to Crude Rate). 



Experience Group; Sex. 


Crude Rate. 


Standardized 
Rate. 


Factor. 


Metropolitan Ind. White Experience, 
1911 to 1916. 
Males 


11.82 
10.40 

12.41 
11.08 


15.09 
12.43 

11.81 
11.11 


1.277 


Females 


1.195 


Registration Area Experience, 1910 to 
1915. 
Males 


.952 


Females 


1.003 







INDEX. 



Abdominal tuberculosis, 62 

, and "dysentery," 265 

Abortions and miscarriages, 203 
Absorption of deleterious gases, 119 
Accidental drowningj 104 
Accidental poisoning, 117 
Accident death rate, improving, 125 
Accident problem in the United 
States, and in England and Wales, 
94 
Accidents, 94 

, according to means of injury, 

100 
Accidents of labor, 204 

, decline in mortality, 210 

, prenatal nursing in prevention 

of, 210 
Accidents of pregnancy, 203 
Accuracy of certified causes of death, 
30, 377 

, increasing deathrates from 

" degenerative diseases," 70 
, communicable diseases of child- 
hood, 188 
Acute accidental poisonings, 117 
Acute articular rheumatism, 242 
Acute bronchitis, 245 

, in children, 245 

Acute endocarditis, 275 
Acute nephritis, 283 

, following infectious diseases, 

283 

, and scarlet fever mortality, 

185 
Acute poliomyelitis, 262 
Adolescence, suicide in, 131 
Adolescent women and suicide, 131 
After-mortality of typhoid fever, 222 
Age composition of insured group, 
comparison with United States 
Registration Area, 5 

389 



Ages, mortality by, from certain 
diseases — see particular disease 

Albuminuria, during pregnancy, 
childbirth and the puerperium, 199 

Albuminuria in the maternal state, 
202 

Alcoholism, 246 

, and cirrhosis of the liver, 223 

, defective and unreliable sta- 
tistics, 223, 248 

AH causes of death, number of 
deaths or death rates by color, sex 
or age,, 11, 13, 14, 34, 304 

, in 1917, 293 

, 1911 to 1916, by single calen- 
dar years, 366 

Anemia, 267 

, chlorosis, 267 

Aneurism, 215 

, and syphilis, 238 

Angina pectoris, 260 

Anterior poliomyelitis, 262 

Antitoxin in diphtheria, 191 

Ajipalaehian Plateau, malaria in the, 
257 

, pellagra in the, 249 

Appendicitis, 233 

Areas included in this study, 2 

Arteries, diseases of the, 215 

Arteriosclerosis, 215 

, and softening of the brain, 

271 

, as "degenerative disease," 

216 

Arthritis deformans, 242 

Asphyxiation, accidental, 119 

, suicidal, 136 

Asthma, 278 

Atheroma, 215 

Atlanta, Ga., pellagra in, 250 

Augusta, Ga., pellagra in, 250 

, malaria in 256 



390 



INDEX. 



Automobile accidents and injuries, 
increasing death rate, 109 

Biliary calculi, 281 

Birmingham, Ala,, pellagra in, 250 

, malaria in^ 256 

Birthrate in relation to maternal 
mortality, 201 

Bladder, cancer of the, 171 

, abscess of the, 285' 

, diseases of the, 285 

Boston, Mass., prenatal nursing in, 
213 

Bright 's disease, 87 

, and carddo'-vascular disease, 87 

, classification difficulties in, 87 

— — , increasing deathrate from, 91 

Bronchial asthma^ 278 

Bronchitis, acute, 245 

Bronchitis, chronic, 241 

Bronchopneumonia, 78 

— ■ — , as unsatisfactory statement of 
cause of death, 30, 379 

, reliability of mortality sta- 
tistics of, 86 

Brownlee, John, 51 

Buccal cavity, cancer of the, 170 

Burns, 106 

Csesarean section, 204 

Cairo, 111., malaria in, 256 

Calculus, biliary, 281 

Campaign against tuberculosis, 59 

Cancer, problem in the United 

States, 147 
, by organs or parts, 148 

> 

stomach and liver, 160 
female genital organs, 163 
breast, 165 
peritoneum, intestines, rectum, 

168 
buccal cavity, 170 
skin, 170 

male genital organs, 171 
, in relation to economic con- 
dition or social status, 155 



Cancer, continued 

; increasing! mortality rates 

from, 156 

, increasing mortality in cer- 
tain age periods, 159 

, and tuberculosis of abdom- 
inal organs, in relation to child- 
bearing, 168 

Cardiac disease — see Heart disease 

, ill-defined, 290 

Cardio-vascular-renal disease and 
cerebral hemorrhage, 173 

Cardio-vascular-renal diseases — see 
Heart disease. Bright 's disease, 
Cerebral hemorrhage and apo- 
plexy, 65, 87, 173 

Causes of death, improved state- 
ments of, 377 

Cerebral hemorrhage and apoplexy, 
173 

Cerebral softening, 271 

Cerebral tumor, 273 

— ■ — , and syphilis, 238 

Cerebrospinal fever, 269 

Cerebrospinal meningitis, 268 

Certification, of diseases causing 
death, 264 

f of cerebral hemorrhage, 173 

■ , of alcoholism, 248 

, improvement in, by system of 

inquiry, 377 

Changes in deathrates, following in- 
quiry to physicians, 377 

Charlotte, N. C, pellagra in, 250 

, malaria in, 256 

Chattanooga, Tenn., pellagra in, 250 

Child-bearing in relation to cancer 
and tuberculosis of the abdominal 
organs, 168 

Childbirth, mortality in, 197, 213 

Children, in wage earners' families, 
mortality ofj 3 

, under one year of age, 7 

, automobile accidents among, 

110 

, communicable diseases of, 178 

, diarrhea and enteritis in, 193 

, convulsions in, 273 



INDEX. 



391 



Chlorosis, 267 

Cholelithiasis, 282 

Chronic bronchitis, 241 

, and certification of tubercu- 
losis, 242 

Chronic pneumonia, 279 

Chronic poisonings, 267 

Chronic recurrent pellagra, 255 

Cirrhosis of the liver, 223 

Classification of causes of death, 9, 
32 

Classification procedure in relation to 
increased deathrate from ' ' degene- 
rative diseases," 70 

Coastal plain of the South, malaxia 
in the, 257 

, pellagra in the, 249 

Cocainism, 267 

Codification processes, 9 

Color or race composition of insured 
group, 4 

Colored males and females, by 
causes of death, see Eaeial mor- 
tality 

Columbia, S. C, pellagra in, 250 

, malaria in, 256 

Columbus, Ga., pellagra in, 250 

, malaria in, 256 

' ' Confinement, ' ' deaths in, 204 

Convulsions, 273 

, puerperal, 202 

, in children, 273 

Corrected deathrates, 385 

Correspondence with physicians to in- 
crease accuracy of certified causes 
of death, 30, 377 

Cystitis, 285 

Deaths, by color^, sex or age, 11, 12, 
34, 304; by single years, 366 

Deathrates — see entries for each 
cause of death 

, by single calendar years, 1911 

to 1916, and by causes of death, 
366; by color and sex, 34 

"Debility," 290 

' ' Degenerative diseases ' ' — see Heart 
disease, Bright 's disease, Cerebral 



hemorrhage and apoplexy, 65, 87, 
173 

Dementia paralytica, 272 

Dementia precox and suicide in ado- 
lescence, 131 

Diabetes mellitus, 229 

, relation to working conditions, 

229 

, and menopause, 230 

, increasing deathrate from, 232 

Diarrhea and enteritis, 193 

, and "dysentery," 265 

Diet in causation of pellagra, 254 

Diphtheria, 189 

Disability among Southern wage 
earners, resulting from pellagra, 
250 

Diseases of the arteries, 215 

Diseases of intestines, 193 

Disseminated tuberculosis, 64 

"Drink habit," statistics of, 248 

"Dropsy," 290 

Drowning, accidental, 104 

, suicidal, 137 

Drunkenness, mortality from, 248 

Dublin, Louis I., 155, 175, 185, 222 

"Dysentery," 264 

Ears, diseases of the, 274 
Eastland disaster, Chicago, 111., 1915, 

105 
Eclampsia, puerperal, 202 
Economic aspects of homicide, 145 
Economic condition, and cancer, 155 

, and diabetes mellitus, 229 

Economic loss, from tuberculosis, 43 

, from heart diseases, 65 

, from diseases of puerperal 

state, 197 
Economic revival in the South, 1916, 

in relation to pellagra mortality, 

255 
Elevator accidents, 115 
Embolism and thrombosis, 276 
Encephalitis, 268 
Endocarditis, acute, 275 
Endometritis, 287 
Enteric fever, 218 



392 



INDEX. 



Enteritis, 193 

Epidemie cerebrospinal meningitis, 

268 
Epidemiology of tuberculosis, 51 
Erysipelas, 265 
Erysipelas, puerperal — see puerperal 

septicemia, 201 
Estimating number of policyholders 

exposed to risk, 8 
External causes, 93 

, classification by, 93 

, by class of violence, 94 

Extra-uterine gestation, 203 

Ealling, deaths from, 102 

Eallopian tubes, cancer of the, 163 

, diseases of the, 287 

Family disintegration and maternal 
mortality, 213 

Fatal accidents, 99 

Fatality rate of childbirth, 213 

Fatigue, and diabetes mortality, 229 

Female genital organs, cancer of the, 
163 

, diseases of the, 287 

I'irearms, accidental deaths from 
use of, 121 

, suicide by, 138 

Floods, mortality from, 105 

' ' Follow-up work ' ' of prenatal clin- 
ics, 213 

Forceps delivery, 204 

Frankel, Lee K., iv 

Frequency curves of tuberculosis 
mortality, 51 

Gall stones, 282 

Gangrene, 288 

Gases, accidental absorption of, 119 

"Gastritis," 280 

Gastroenteric tuberculosis, 62 

Gastroenteritis, 193 

General paralysis of the insane, 272 

General paralysis of the insane, 

and syphiliSj 237 
Glottis, edema of the, 277 
GoDococcus infection, 266 



Gonorrhea, 266 

Gout, 242 

Great Britain, types of tuberculosis 
mortality in, 51 

, accident problem in, 94 

Greensboro, N. C, pellagra in, 250 

Habit poisonings, 267 
Hanging, suicides from, 137 
Health conditions of wage earners, 25 
Heart disease, among adult males, 65 

, disability resulting from, 65 

, burden upon wage earners' 

families, 65 
— • — , classification ofj 70 

, increasing deathrates for, 70 

, unsatisfactory reports of, 71 

"Heart failure," 290 

Hepatitis, 282 

Hernia, 235 

Hoffman, Frederick L., 23, 156 

Homicides, definition, 93 

, statistics, 139 

, problem in the United States, 

139 
Hours of labor, a factor in wage 

earners' mortality, 26 
Hypostatic pneumonia, 278 

Icterus, 282 
Ill-defined diseases, 290 
Illuminating gas poisoning, acci- 
dental, 119 
Immunity in negroes 
Measles, 179 
Scarlet fever, 182 
Improvement in wage earners' mor- 
tality 
All causes of death, 26 

Compared with Eegistration 
area, 27 
Tuberculosis of the lungs, 55 
Abdominal tuberculosis, 63 , 
Communicable diseases of child- 
hood, 178 
Diarrhea and enteritis, 196 
Puerperal diseases, 208 
Typhoid fever, 222 



INDEX. 



393 



Improvement in wage earners' mor- 
tality, continued 
Pellagra, 254 
Malaria, 259 

Improvement of statistics of causes 
of death through supplementary 
inquiries to physicians, 31, 377 

Increasing death rate, for ** de- 
generative diseases," 70 

, for lobar pneumonia, 77 

, for automobile accidents, 109 

, for diabetes mellitus, 232 

"Indigestion," 280 

Industrial accidents, 115, 123 

Industrial conditions and pellagra, 
249, 254 

Industrial hazards and mortality, 123 

Industrial hygiene, a factor in wage 
earners' mortality, 26 

Industrial insurance, 25 

Industrial insurance mortality ex- 
perience as influenced by visiting 
nursing, 214 

Infantile diarrhea, 193 

Infants, mortality of, 7 

Infectious diseases of childhood, 178 

Influenza, 226 

Inguinal hernia, 235 

Injuries at birth, 204 

Inquiry system to improve certifi- 
cation of causes of death, 377 

Intensity of labor, a factor in wage 
earners' mortality, 26 

Intestinal diseases, 193 

Intestinal obstruction, 235 

Intestines, cancer of the, 168 

International List of Causes of 
Death, 9, 32 

, Number of deaths classified by 

color and sex (34)^ by age (304), 
and by single calendar years, 1911 
to 1916, (366) 

Ireland, tuberculosis mortality types 
in, 51 

Jackson, Tenn., pellagra in, 250 

, malaria in, 256 

Jaundice. 282 



Jointly returned causes of death, 
classification of, 9, 32 

Kidneys, cancer of the, 171 

, diseases of the, 284 

Knight, Augustus S., 155 
Knoxville, Tenn., pellagra in, 250 
Kopf, Edwin W., iv 

Labor (in childbirth), mortality dur- 
ing, 199 

Laryngismus stridulus, 277 

Laryngitis, 277 

Larynx, diseases of the, 277 

Life consei'vation resulting from 
prenatal work, 213 

iLife insurance companies, public 
health statistics of, iv 

Little Eock, Ark., pellagra in, 250 

, malaria in, 256 

Liver, abscess of the, 282 

• -, cancer of the, 160 

, diseases of the, 282 

Lobar pneumonia, 73 

, increasing death rate from, 77 

Locomotor ataxia, 270 

, and syphilis, 237 

, Wassermann reaction in, 271 

Ludwig's angina, 280 

I-ues, see syphilis 

Macon, Ga., pellagra in, 250 

, malaria in, 256 

Malaria, 256 

Malaria and pellagra, and the effi- 
ciency of iSouthern wage earners, 
249, 254 

Male genital organs, cancer of the, 
172 

Malignant disease and anemia, 267 

Massachusetts, malaria in, 256 

Maternal mortality, 197 

, methods of studying, 197 

, in relation to age, 200 

, prevention of, 213 

Measles, 179 

, immunity in negroes, 179 



394 



INDEX. 



Medical selection in relation to 
tuberculosis mortality, 53 

Membranous croup, 189 

Memphis, Tenn., pellagra in, 250 

, malaria in, 256 

Meningitis, 268 

Menopause, 287 

, ia relation to diabetes mortal- 
ity in women, 230 

Mental diseases in adolescence, 131 

Michigan, malaria in, 256 

Middle Atlantic States, poliomyelitis 
■epidemic in, 1916, 262 

Miners' asthma, 278, 279 

Miscarriages, 203 

Morphine habit poisoning, 267 

Mortality among wage earners, im- 
provement in, 26 

— — , during 1917, by causes of 
death, 293 

Mortality from occupational causes, 
123 

Mortality of childhood, 185 

Mosquito problem and malaria, 256 

Murder, 139 

Nashville, Tenn., pellagra in, 250 

, malaria in, 256 

Negroes, cerebral hemorrhage certi- 
fication in deaths of, 175 

, immunity among 

from measles, 179 
from scarlet fever, 182 

, higher typhoid fever death- 
rate among, 219 

, and pellagra, 249 

, deathrates among, see Eaeial 

mortality 

Negro women, and puerperal mortal- 
ity, 199 

, illegitimacy a factor in ma- 
ternal deathrate of, 201 

, puerperal hemorrhage in older, 

204 

Nervous system, diseases of the, 273 

Neurasthenia, 273 

Newark, N. J., poliomyelitis epi- 
demic in, 1916, 263 



New England States, poliomyelitis 
epidemic in, 1916, 262 

New Jersey, malaria in, 256 

New Orleans, La., pellagra in, 250 

, malaria in, 256 

New York City, poliomyelitis epi- 
demic in, 1916, 262 

New York City, prenatal nursing in, 
213 

Nomenclature and classification of 
diseases, 9, 32 

Northern States, pellagra in, 252 

, malaria in, 256 

Number of insured wage earners, 
estimating, 8 

Occupational and industrial hazards, 
123 

Occupations, classification of, 9 

, causes of death in, 10 

Occupational hazard in industrial in- 
sura-nce mortality, 2 

Occupations of insured wage earn- 
ers, 2 

Ohio Eiver floods, 1913, 105 

Old age, 288 

Old age, cerebral hemorrhage mortal- 
ity in, 175 

"Old Age," deathrate from, and 
"degenerative diseases," 289 

Opium poisoning, 267 

Organic diseases of the heart — see 
Heart disease, 65 

Osier, William, 218 

Otitis media, '274 

Ovaries, cancer of the, 163 

Ovaritis, 288 

Paducah, Ky., malaria in, 256 

"Paralysis," deathrate from, 176 

Paresis, syphilis in relation to, 237 

Pellagra, 249 

, an economic problem in the 

South, 249, 254 

, and diet, 254 

, in relation to economic and so- 
cial conditions, 249, 254 

Pennsylvania, malaria in, 256 



INDEX. 



395 



Pericarditis, 274 

Peritoneum, tuberculosis of the, 62 

, cancer of the, 168 

"Peritonitis," 283 

, unsatisfactory statement of 

cause of death, 31 

— , and appendicitis, 233 

Pernicious anemia, 267 

Pharyngitis, 280 

Pharynx, diseases of the, 279 

Philadelphia, Pa., poliomyelitis epi- 
demic in, 1916, 263 

Physicians helping to complete data 
on wage earners' mortalityj iv, 378 

Placenta previa, 203 

Pneumokoniasis, 279 

Pneumonia, 72 

Pneumonia — ^lobar and undefined — 
see Lobar pneumonia, 73 

* ' Pneumonia, ' ' unsatisfactory report 
■of cause of death, 77 

Poisoning, accidental, 117 

Poisoning, suicidal, 135 

Poisonings, chronic, 267 

Poliomyelitis, 262 

Poplar Blufif, Mo., pellagra in, 250 

, malaria in, 256 

Pregnancy index, for maternal mor- 
tality study, 200 

Pregnancy, mortality in, 198 

Premature birth (death of mother), 
203 

Prenatal clinics in control of ma- 
ternal mortality, 213 

Prenatal nursing, in control of mor- 
tality from puerperal albuminuria 
and convulsions, 209 

, in relation to accidents of 

labor, 211 

, in public health work of Amer- 
ican cities, 213 

Prolapse of the uterus, 287 

Prostate, cancer of the, 172 

, diseases of the, 285 

Proteid diet in pellagra, 254 

Prudential Insurance Company of 
America, 23 



Public health administration and 
typhoid fever control, 218 

Public health movement and the dis- 
eases of children, 178 

Public health statistics of wage 
earners, 1 

Public health work in relation to 
tuberculosis, 59 

Puerperal albuminuria and convul- 
sions, 202 

, and renal and hepatic dis- 
eases, 210 

Puerperal diseases, 197 

, prevention of, 213 

Puerperal eclampsia, 202 

Puerperal hemorrhage, 203 

Puerperal hemorrhage, lower mortal- 
ity rate from, among wage earning 
population, 211 

Puerperal septicemia, 201 

, as affecting periods of the 

puerperal state, 199 

, and "septicemia," unquali- 
fied, 266 

Puerperium, mortality during, 199 

PiUmonary apoplexy, 277 

Pulmonary congestion, 277 

Purulent infection and septicemia, 
265 

Pylorus, diseases of the, 281 

Pyosalpingitis, 288 

Q-uinsy, 280 

Race composition of insured group, 4 
Race factors in industrial insurance 

mortality, 3 
Racial mortality from certain dis- 
eases, see particular disease. 
Railroad accidents and injuries, 107 
Raleigh, N. C.^ pellagra in, 250 

; malaria in, 256 

Rectum, cancer of the, 168 

Registration Area of United States, 

age composition of population of, 5 

Registration Area of United States 

Mortality by sex and by age in 



396 



INDEX. 



United States and among in- 
sured wage earners compared. 
All causes of death, 23 
Tuberculosis of the lungs, 52 
Tuberculous meningitis, 61 
Abdominal tuberculosis, 64 
Organic diseases of the heart, 

68 
Lobar pneumonia, 76 
Bronchopneumonia, 85 
Bright 's disease, 90 
Accidents, 99 

Traumatism by falling, 103 
Suicides, 132 
Homicides, 144 
Cancer, 154 

of the stoma,ch, 162 
of the female genital or- 
gans, 164 
of the breast, 167 
Cerebral hemorrhage and apo- 
plexy, 176 
Measles, 180' 
Scarlet fever, 183 
Whooping cough, 187 
Diphtheria and croup, 190 
Diarrhea and enteritis, 195 
Puerperal diseases, 204 
Eenal disease in causation of puer- 
peral eclampsia, 210 
Eheumatic fever^ 242 
" Eheumatism, " 242 
Eichmond, Va., pellagra in, 250 
Eoanoke, Va.^ pellagra in, 250 

Salpingitis, 287 

Sanitary index, typhoid fever as, 218 
St. Louis, Mo.j malaria in, 256 
Savannah, Ga., pellagra in, 250 

, malaria in, 256 

Scarlet fever, 182 

, immunity of negroes, 182 

, in urban communities, 184 

Sclerosis of brain, 273 
Self -induced abortion, 203 
Senility, 289 
Sequelae of typhoid fever, 222 



Sepsis, puerperal — see puerperal sep- 
ticemia, 2U1 

Septicemia, 265 

Septicemia, puerperal^-see Puerperal 
septicemia, 201 

Sex composition of insured group, 4 

Sex, mortality from certain diseases 
by, see particular disease 

Shooting, accidental, 121 

Simple meningitis, 268 

Simple peritonitis, 282 

Skin, cancer of the, 170 

Social conditions in relation to dia- 
betes mortality, 229 

Social research into wage earners' 
family problems, 26 

Social statistics of insured wage 
earners, 1 

Social status and cancer, 155 

Softening of the brain, 271 

South, pellagra in, 249, 254 

, malaria in, 257 

Southwest, pellagra in, 249 

, malaria in, 257 

Spartanburg, S. C, pellagra in, 250 

Spasmodic asthma, 278 

Spasmodic croup, 277 

Spinal meningitis, 268 

Standard million of population, 385 

Standard of living in wage earners' 
families, 26 

Standardized, or corrected death 
rates, 385 

States included in this study, 2 

Steam railroad accidents and in- 
juries, 107 

Stomach, cancer of the, 160 

, diseases of the, 280 

, ulcer of the, 261 

Stouman, Knud, 234 

Street car accidents and injuries, 112 

"Sudden death," 290 

Suicide statistics, 126 

— — , problem among wage earners 
127 

, in adolescence, 131 

■ — — , by means of injury, 135 
poison, 135 



INDEX. 



397 



Suicide statistics, continued 
asphyxia, 136 
drowning, 137 
firearms, 137 

hanging or strangulation, 137 
Suppurative otitis media, 274 
Syphilis, 237 

Syphilis, and cirrhosis of the liver, 
223 

, as a cause of locomotor ataxia 

and general paralysis of the in- 
sane, 237 

, certification, 237 

, and softening of the brain, 271 

, and general paralysis of the 

insane, 272 

Tabulating machines, 10 

Technical processes of compiling 
wage earners' mortality statis- 
tics, 8 

Thrombosis, 276 

Tonsillitis, 280 

Tonsils, diseases of the, 280 

Traumatism, by falling, 102 

, by firearms, 121 

, by machines, 115 

Tubal gestation, 203 

Tuberculosis, 43 

, disability resulting from, 43 

, campaign in United States, 43 

, need for wage earners' mor- 
tality statistics of, 43 

, burden upon wage earners' 

families, 43 

, by organs or parts, 44 

, among negroes, 45, 46 

, type curves, 51 

, in wage earners' children, 53 

, in rural areas, 53 

, effect of campaign against, 57 

, of abdominal organs in fe- 
males, and ehildbearing, 168 

■ , and maternal mortality, 197 

, and the pellagra' problem in 

the South, 250 

Tuberculous meningitis, 59 

Tuberculous peritonitisj 62 



Tuberculous peritonitis, and "peri- 
tonitis," 283 

Tumor, uterine, 286 

Types of tuberculosis mortality 
curves, 51 

Typhlitis, 233 

Typhoid fever, 218 

, in childhood, 220 

, sequelEB, 222 

Ulcer of the stomach, 261 
Unknown causes of death, 290 
Urban life, factor in wage-earners' 

mortality, 7, 25 
Uterine tumor, 286 
Uterus, cancer of the, 163 

, diseases of the, 286 

, abscess of the, 287 

Van Buren, George H., iv 
Vehicles, accidents from other, 113 
Venereal disease mortality, 237, 266 
Verifying punched cards, 10 
Vincent's angina, 280 
Violent deaths, classification, 93 
Visiting Nurse Service, Metropoli- 
tan Life Insui^iice Company, ma- 
ternity nursing, 213 
Vital statistics of old age, 175 

Wage earners' efficiency in relation 
to pellagra and malaria, 249, 254 

Wage earners' mortality statistics, 
factors influencing, 25 

, uses of, in public health 

movement, iii 

Wage earners' suicide problem, 132 

War deaths, .classification, 93 

, during 1917, 298 

Wassermann reaction in locomotor 
ataxia, 271 

White insured wage earners, mortal- 
ity, 3 

Whooping cough, 186 

, mortality among negroes, 187 

WiUcox, Walter F., 157 

Women in wage earners' families, 
mortality of, 3 

Work-accidents, 123 



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